Manual chest compressions for cardiac arrest – With or without mechanical CPR?

Introduction: Resuscitation from out-of-cardiac arrest (OHCA) requires control of both chest compressions and lung ventilation. There are few effective methods for detecting ventilations during cardiopulmonary resuscitation. Thoracic impedance (TI) is sensitive to changes in lung air volumes and may allow detection of ventilations but has not been tested with concurrent mechanical chest compressions. Hypothesis: It is possible to automatically detect and characterize ventilations from TI changes during mechanical chest compressions. Methods: A cohort of 420 OHCA cases (27 survivors to hospital discharge) were enrolled in the Dallas-Fort Worth Center for Resuscitation Research cardiac arrest registry. These patients were treated with the LUCAS-2 CPR device and had concurrent TI and capnogram recordings from MRx (Philips, Andover, MA) monitor-defibrillators. We developed a signal processing algorithm to suppress chest compression artifacts from the TI signal, allowing identification of ventilations. We used the capnogram as gold standard for delivered ventilations. We determined the accuracy of the algorithm for detecting capnogram-indicated ventilations, calculating sensitivity, the proportion of true ventilations detected in the TI, and positive predictive value (PPV), the proportion of true ventilations within the detections. We calculated per minute ventilation rate and mean TI amplitude, as surrogate for tidal volume. Statistical differences between survivors and non-survivors were assessed using the Mann-Whitney test. Results: We studied 4331 minutes of TI during CPR. There were a median of 10 (IQR 6-14) ventilations per min and 52 (30-81) ventilations per patient. Sensitivity of TI was 95.9% (95% CI, 74.5-100), and PPV was 95.8% (95% CI, 80.0-100). The median ventilation rates for survivors and non-survivors were 7.75 (5.37-9.91) min -1 and 5.64 (4.46-7.15) min -1 (p<10 -3 ), and the median TI amplitudes were 1.33 (1.03-1.75) Ω and 1.14 (0.77-1.66) Ω (p=0.095). Conclusions: An accurate automatic TI ventilation detection algorithm was demonstrated during mechanical CPR. The relation between ventilation rate during mechanical CPR and survival was significant, but it was not for impedance amplitude.

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Military application of mechanical CPR devices: a pressing requirement?

Journal of the Royal Army Medical Corps ◽

10.1136/jramc-2018-000908 ◽

2018 ◽

Vol 164 (6) ◽

pp. 438-441

Author(s):

Iain T Parsons ◽

A T Cox ◽

P S C Rees

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Potential Utility ◽

Operational Environment ◽

Chest Compressions ◽

High Quality ◽

Military Application ◽

The Military ◽

Mechanical Cpr

Maintaining high-quality chest compressions during cardiopulmonary resuscitation following cardiac arrest presents a challenge. The currently available mechanical CPR (mCPR) devices are described in this review, coupled with an analysis of the evidence pertaining to their efficacy. Overall, mCPR appears to be at least equivalent to high-quality manual CPR in large trials. There is potential utility for mCPR devices in the military context to ensure uninterrupted quality CPR following a medical cardiac arrest. Particular utility may be in a prohibitive operational environment, where manpower is limited or where timelines to definitive care are stretched resulting in a requirement for prolonged resuscitation. mCPR can also act as a bridge to advanced endovascular resuscitation techniques should they become more mainstream therapy.

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Abstract 100: Mechanical Devices Are More Effective than Manual Compressions Regarding Resuscitation Concomitant with Emergency Percutaneous Coronary Intervention in Cardiac Arrest

Circulation ◽

10.1161/circ.130.suppl_2.100 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Luis A Dallan ◽

Tulio T Vargas ◽

Bruno L Janella ◽

Jamil R Cade ◽

Breno O Almeida ◽

...

Keyword(s):

Blood Pressure ◽

Percutaneous Coronary Intervention ◽

Cardiac Arrest ◽

Coronary Angiography ◽

Coronary Angioplasty ◽

Coronary Intervention ◽

Percutaneous Coronary Interventions ◽

Chest Compressions ◽

Percutaneous Coronary ◽

Mechanical Cpr

Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual chest compressions prevents the continuity of coronary angiography and coronary angioplasty and require the assistance of trained staff in cardiopulmonary resuscitation (CPR) quickly and accurately. AutoPulse® is a mechanical CPR device that consists of mechanical pneumatic band attached to a board that involves the patient’s chest and allows effective and continuous pneumatic compressions, allowing mechanical CPR simultaneously to coronary angiography and angioplasty. Hypothesis: We assessed the hypothesis that mechanical CPR may be feasible during percutaneous coronary interventions and more effective than manual CPR by the analysis of intra-coronary pressure curves. Methods: The device was used in 6 consecutive cases of cardiac arrests (ventricular fibrillation refractory to attempts of defibrillation and standard treatment) in the Cath Lab, allowing continuity of percutaneous coronary intervention concomitant with CPR. Intra-coronary curves were measured initially during manual chest compressions (manual CPR) and later, after the correct installation of AutoPulse® during mechanical compressions with this device (mechanical CPR). Results: It was possible to complete coronary angiography with the device attached to the patient in all cases, and it was also possible to complete coronary angioplasty during mechanical CPR. In all cases, mechanical CPR provided uninterrupted chest compressions more effectively and always stable in stead of manual compressions. Although a mean blood pressure of 40mmHg in both methods, mechanical CPR was able to maintain this pressure for a long time, but manual CPR had an important reduction in mean blood pressure after two minutes of CPR in all cases. Conclusions: In conclusion, percutaneous coronary interventions are feasible concurrent with mechanical CPR using AutoPulse® in patients suffering cardiac arrest in the Cath Lab. The device provided uninterrupted chest compressions more effective than manual compressions, as well as allowed the freedom of the physicians to attempt other functions, different from CPR, during the procedures.

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Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human

BMJ Open ◽

10.1136/bmjopen-2020-042062 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042062

Author(s):

Manuel Obermaier ◽

Johannes B Zimmermann ◽

Erik Popp ◽

Markus A Weigand ◽

Sebastian Weiterer ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Meta Analysis ◽

Bibliographic Databases ◽

Chest Compressions ◽

Term Survival ◽

Statistical Heterogeneity ◽

Mechanical Cpr

IntroductionCardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest.Methods and analysisA sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I2-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Ethics and disseminationNo ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences.PROSPERO registration numberCRD42017051633.

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Thoracic Spine Fracture in a Survivor of Out-of-Hospital Cardiac Arrest with Mechanical CPR

Prehospital and Disaster Medicine ◽

10.1017/s1049023x16000844 ◽

2016 ◽

Vol 31 (6) ◽

pp. 684-686 ◽

Cited By ~ 3

Author(s):

Robert Trevor Marshall ◽

Hemang Kotecha ◽

Takuyo Chiba ◽

Joseph Tennyson

Keyword(s):

Cardiac Arrest ◽

Vertebral Fracture ◽

Thoracic Spine ◽

Spine Fracture ◽

Chest Compressions ◽

Publication Type ◽

Thoracic Spine Fracture ◽

Mechanical Cpr ◽

Hospital Cardiac Arrest ◽

Male Survivor

AbstractThis is a report of a thoracic vertebral fracture in a 79-year-old male survivor of out-of-hospital cardiac arrest with chest compressions provided by a LUCAS 2 (Physio-Control Inc.; Lund Sweden) device. This is the first such report in the literature of a vertebral fracture being noted in a survivor of cardiac arrest where an automated compression device was used.MarshallRT, KotechaH, ChibaT, TennysonJ. Thoracic spine fracture in a survivor of out-of-hospital cardiac arrest with mechanical CPR. Prehosp Disaster Med. 2016;31(6):684–686.

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Faculty Opinions recommendation of Chest compressions versus ventilation plus chest compressions in a pediatric asphyxial cardiac arrest animal model.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2838957.2504055 ◽

2010 ◽

Author(s):

Gideon Paret ◽

Marianne Nellis

Keyword(s):

Animal Model ◽

Cardiac Arrest ◽

Chest Compressions ◽

Asphyxial Cardiac Arrest

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Faculty Opinions recommendation of Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735745664.793561757 ◽

2019 ◽

Author(s):

Paul H Mayo ◽

Karan Singh

Keyword(s):

Animal Model ◽

Cardiac Arrest ◽

Chest Compressions ◽

Closed Chest ◽

Traumatic Cardiac Arrest

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The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073636 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3636

Author(s):

Yi-Rong Chen ◽

Chi-Jiang Liao ◽

Han-Chun Huang ◽

Cheng-Han Tsai ◽

Yao-Sing Su ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Primary Outcome ◽

Medical Service ◽

Spontaneous Circulation ◽

High Quality ◽

Urban City ◽

Service Response Time ◽

Mechanical Cpr ◽

Hospital Cardiac Arrest

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

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