Mechanical chest-compression devices: current and future roles.
ABSTRACT 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.
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ABSTRACT: We will describe the implementation of the LUCAS™1 chest compression device as standard equipment in the treatment of cardiac arrest across a large ambulance service and provide descriptive data on device-treated arrests and provider experience during the initial 2 years of use. Provider training and deployment of 38 devices occurred in our 70-vehicle, 400-provider ambulance service within 3 months. A retrospective case series of device-eligible out-of-hospital cardiac arrests occurring between May 2008 and June 2010 was analyzed. Clinical data were extracted from an electronic prehospital patient care record and information on provider experience with the device was collected via online survey. LUCAS™1 was used in 79% of resuscitation attempts (498 of 631). Primary reasons for nonuse were resuscitation of limited duration and extreme body size. Return of spontaneous circulation (ROSC) was documented in 35% and 41% of device- and non-device-treated arrests, respectively (p = 0.31), but among arrests where time from arrival at patient to discontinuation of cardiopulmonary resuscitation was >5 min, the rates were 26% and 24%, respectively (p = 0.78). A large ambulance service in the United States initiated standard use of a mechanical compression device within 3 months. In an applied setting, the LUCAS™1 device fits most patients and was well received by prehospital providers. Resuscitation of limited duration due to early death or early ROSC frequently precludes device use, and this has important implications for evaluating the association between device use and ROSC in observational settings.Journal of Emergency Medicine 08/2013; · 1.33 Impact Factor
- Resuscitation 09/2013; 84(9):1159-60. · 4.10 Impact Factor
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ABSTRACT: Objective To compare integrated automated load distributing band CPR (iA-CPR) with high-quality manual CPR (M-CPR) to determine equivalence, superiority, or inferiority in survival to hospital discharge. Methods Between March 5, 2009 and January 11, 2011 a randomized, unblinded, controlled group sequential trial of adult out-of-hospital cardiac arrests of presumed cardiac origin was conducted at three US and two European sites. After EMS providers initiated manual compressions patients were randomized to receive either iA-CPR or M-CPR. Patient follow-up was until all patients were discharged alive or died. The primary outcome, survival to hospital discharge, was analyzed adjusting for covariates, (age, witnessed arrest, initial cardiac rhythm, enrollment site) and interim analyses. CPR quality and protocol adherence were monitored (CPR fraction) electronically throughout the trial. Results Of 4753 randomized patients, 522 (11.0%) met post enrollment exclusion criteria. Therefore, 2099 (49.6%) received iA-CPR and 2132 (50.4%) M-CPR. Sustained ROSC (emergency department admittance), 24 hour survival and hospital discharge (unknown for 12 cases) for iA-CPR compared to M-CPR were 600 (28.6%) vs. 689 (32.3%), 456 (21.8%) vs. 532 (25.0%), 196 (9.4%) vs. 233 (11.0%) patients, respectively. The adjusted odds ratio of survival to hospital discharge for iA-CPR compared to M-CPR, was 1.06 (95% CI 0.83–1.37), meeting the criteria for equivalence. The 20 minutes CPR fraction was 80.4% for iA-CPR and 80.2% for M-CPR. Conclusion Compared to high-quality M-CPR, iA-CPR resulted in statistically equivalent survival to hospital discharge.Resuscitation 01/2014; · 4.10 Impact Factor