It is recognized that the quality of cardiopulmonary resuscitation (CPR) is an important predictor of outcome from cardiac arrest yet studies consistently demonstrate that the quality of CPR performed in real life is frequently sub-optimal. Mechanical chest-compression devices provide an alternative to manual CPR. This review will consider the evidence and current indications for the use of these devices.
Physiological and animal data suggest that mechanical chest-compression devices are more effective than manual CPR. However, there is no high quality evidence showing improved outcomes in humans. There are specific circumstances where it may not be possible to perform manual CPR effectively for example, during ambulance transport to hospital, en-route to and during cardiac catheterization, prior to organ donation and during diagnostic imaging where using these devices may be advantageous.
There is insufficient evidence to recommend the routine use of mechanical chest-compression devices. There may be specific circumstances when CPR is difficult or impossible where mechanical devices may play an important role in maintaining circulation. There is an urgent need for definitive clinical and cost effectiveness trials to confirm or refute the place of mechanical chest-compression devices during resuscitation.
"M-CPR devices are a valid alternative to manual chest compressions, showing an increase in quality of CPR performed by two-member response teams, and during diagnostic or therapeutic procedures such as CT scan or PCI. They may also be used for ongoing CPR during patient transportation, especially if a potentially reversible cause is suspected [1, 2]. M-CPR has been associated with an increased risk of internal injuries when compared to manual resuscitation. "
[Show abstract][Hide abstract] ABSTRACT: Mechanical cardiopulmonary resuscitation (m-CPR) devices are an alternative to manual CPR, but their efficacy has been subject to debate. We present a case of a patient with full-neurologic recovery after prolonged m-CPR. The patient presented with severe hypothermia (internal temperature 24°C) and poisoning (sedatives/hypnotics). Hepatic perfusion and metabolism are considered keys to restore spontaneous circulation. During this period no problems related to the device or patient positioning were encountered. Delivery of high-quality CPR and prolonged resuscitation were achieved. We confirm that ventilations asynchronous with chest compressions can be a problem. Reduction in chest measurements can hamper lung ventilation. A synchronous mode of manual ventilation (30 : 2) seems to be the best solution. The patient had an initial period of manual CPR. No damage to any organ or structure was noted. This case is of further interest because our EMS helicopters can fly 24 hours a day and m-CPR devices could play an important role as a "bridge" in patients when active rewarming by cardiopulmonary bypass is indicated (CPB).
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