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Mechanical CPR Devices - The current evidence

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Mechanical CPR Devices - The current evidence

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Mechanical CPR Devices - The current evidence

  1. 1. Mechanical CPR Humans Optional
  2. 2. Objectives ✤ Why they were developed. ✤ How they work. ✤ Current evidence. ✤ When they are useful. ✤ When they are not so useful. ✤ What next?
  3. 3. 01 Why? ✤ 15000 OHCA per year ✤ Only roughly 10% of OHCA will survive ✤ Most important factors Early defibrillation Early, high quality and uninterrupted chest compressions.
  4. 4. 01 Chest Compressions ✤ High quality1,2,3,4 ✤ Uninterrupted5
  5. 5. 01 Mechanical CPR Pneumatic Piston ✤ LUCAS (Lund University Cardiac Assist System) ✤ Michigan Thumper
  6. 6. 01 Mechanical CPR Load distributing band ✤ Zoll Autopulse
  7. 7. 01 Mechanical CPR ✤ LUCAS 2 How to use.
  8. 8. ✤ 2015 ✤ Systematic review ✤ RCT’s ✤ Over 10000 patients ✤ OHCA: atraumatic ✤ Comparing manual to mechanical CPR
  9. 9. Autopulse ✤ ASPIRE ✤ CIRC LUCAS ✤ Smekal et al. ✤ LINC ✤ PARAMEDIC
  10. 10. ASPIRE 2006 - Autopulse ✤ USA/Canada ✤ Cluster RCT ✤ 767 patients ✤ Trial terminated early ✤ Discharge from hospital Manual 9.9% Autopulse 5.8%
  11. 11. CIRC 2014 - Autopulse ✤ USA/Europe ✤ Multi-centre RCT. ✤ 4753 patients. ✤ Survival hospital discharge Autopulse 9.4% Manual 11% Odds ratio 1.06
  12. 12. LINC 2014 - LUCAS ✤ UK/Sweden/Netherlands ✤ Multi-centre RCT. ✤ 2589 patients. ✤ Survival 4 hours Manual 23.7% LUCAS 23.6%
  13. 13. PARAMEDIC 2015 - LUCAS ✤ UK ✤ Multi-centre cluster RCT ✤ 4471 patients. ✤ Survival 30 days Manual 7% LUCAS 6%
  14. 14. Meta-analysis ✤ Mechanical CPR showed no advantage for ROSC Survival to discharge Survival with CPC 1 or 2
  15. 15. MECCA 2017 - LUCAS ✤ Singapore ✤ Multi-centre RCT ✤ 1191 patients. Survival to discharge ✤ As treated analysis Manual 2.9% Early LUCAS 5.8% Late LUCAS 2%
  16. 16. Current Guidelines ✤ ANZCOR ANZCOR suggests against the routine use of automated mechanical chest compression devices to replace manual chest compressions (CoSTR 2015 weak recommendation, moderate quality of evidence).2 ANZCOR suggests that automated mechanical chest compression devices are a reasonable alternative to high-quality manual chest compressions in situations where sustained high- quality manual chest compressions are impractical or compromise provider safety (CoSTR 2015, weak recommendation, low quality evidence).2
  17. 17. 01 When is it useful? ✤ Limited rescuers ✤ Transfers ✤ Prolonged CPR ✤ PCI6,7,8 ✤ ECMO9
  18. 18. 01 When are they not so useful? ✤ Fat/big ✤ Skinny ✤ Kids ✤ Trauma ✤ Poor placement
  19. 19. 01 What next? ✤ Further Research Early use of mechanical CPR In hospital use
  20. 20. References 1. Hightower D, Thomas SH, Stone CK, et al. Decay in quality of closed-chest compressions over time. Annals of emergency medicine. 1995; 26(3):300-3. 2. Ochoa FJ, Ramalle-Gómara E, Lisa V, et al. The effect of rescuer fatigue on the quality of chest compressions. Resuscitation. 1998; 37(3):149-52 3. Idris AH, Guffey D, Pepe PP, et al. Chest compression rates and survival following out-of-hospital cardiac arrest. Crit Care Med 2015;43:840–8. 4. Stiell IG, Brown SP, Christenson J, et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012;40:1192-8. 5. Cheskes S, Schmicker R, Christenson J et al. Peri-shock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation. 2011;124(1):58-66. 6. Preethi W, Rao P, Kanakadandi UB, et al. Mechanical cardiopulmonary resuscitation in and on the way to the cardiac catheterization laboratory. Circ J 2016; 80: 1292–1299. 7. Wagner H, Terkelsen CJ, Friberg H, et al. Cardiac arrest in the catheterisation laboratory: a 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. Resuscitation 2010; 81: 383–387. 8. Wagner H, Hardig BM, Rundgren M, et al. Mechanical chest compressions in the coronary catheterization laboratory to facilitate coronary intervention and sur- vival in patients requiring prolonged resuscitation efforts. Scand J Trauma Resusc Emerg Med 2016; 24: 4 9. Stub D, Bernard S, Pellegrino V, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resus- citation 2015; 86: 88–94.

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