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Advances in Automated CPR  A/Prof Marcus Ong Consultant, Senior Medical Scientist & Director of Research Department of Emergency Medicine Singapore General Hospital Adjunct Associate Professor Duke-NUS Graduate Medical School Office of Research
Chain of Survival Courtesy of Life Support Training Centre, Singapore General Hospital
Introduction ,[object Object],[object Object]
Aortic diastolic (red) and right atrial (yellow) pressures during CPR (2 ventilations in 4-second period)
Chest Compressions and  Coronary Perfusion Pressure CPP at 5:1 Ratio CPP at 15:2 Ratio
2006 ACLS Guidelines ,[object Object],[object Object]
Thumper   Model 1007 Mechanical CPR System
X-CPR (automatic simultaneous sternothoracic CPR, SST-CPR, device)
Lund University Cardiopulmonary Assist System (LUCAS)
AutoPulse ,[object Object],[object Object],[object Object]
 
Introduction ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Introduction
[object Object],[object Object],[object Object],[object Object]
Methods ,[object Object],[object Object],[object Object]
Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Methods
Utstein reporting template for data elements Resuscitation attempted N = 381 Resuscitation not attempted (pronounced dead on scene, DNR etc) N = 1256 Presumed cardiac etiology N =284 Non-cardiac etiology N = 255 LDB-CPR phase N= 284 STD-CPR phase N= 499 STD-CPR phase Absence of signs of circulation and/or considered for resuscitation (age   18) N= 1475 LDB-CPR phase Absence of signs of circulation and/or considered for resuscitation (age   18) N= 819 Resuscitation attempted N = 657 Presumed cardiac etiology N = 499 Device applied N= 210 Device not applied N= 74 (Reason missing =2) Not indicated N= 50 Not available N= 14 Mechanical failure N= 4 Inability to fit N= 4 Cease resuscitation N= 22 ROSC N= 20 En route N= 8
Study patients by phases   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient Demographics (N=908) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient Demographics (N=908) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ROSC (%) by phases ,[object Object]
Comparison of ROSC by Phases ,[object Object],[object Object]
Survival to Admission (%) by Phases ,[object Object]
Comparison of Survival to Admission by Phases ,[object Object],[object Object]
Survival to Discharge (%) by Phases ,[object Object]
Comparison of Survival to Discharge by Phases ,[object Object],[object Object],[object Object]
CPC/OPC by Phases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Number Needed to Treat for outcome ‘survival to discharge’ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Relationship between response time and survival to hospital discharge by phases for patients not witnessed by EMS 1/37 (2.7, 0.5 – 13.8) 3/103 (2.9, 1.0 - 8.2) > 8 15/185 (8.1, 5.0 – 13.0) 6/323 (1.9, 0.9 - 4.0) <8 Survival  N (%, 95% CI) Survival  N (%, 95% CI) Ambulance response time interval [min] LDB-CPR STD-CPR
Survival to hospital discharge for manual and A-CPR stratified by 3 month periods
[object Object],[object Object],[object Object]
 
Reconciling the results ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Reconciling the results
Interruptions to CPR during device deployment
QCPR variables (1 st  5 mins) after Autopulse Implementation 0.50 (0.28) 0.25 (0.13) NFR  150.82 (83.89) 76.29 (39.92) NFT  34.76 (23.98) 39.78 (24.26) Compression/min  102.93 (28.00) 128.00 (14.19) Compression rate/min  34.86 (21.49) 33.26 (20.19) Compression ratio  AutoPulse (n=29) Manual CPR (n=23) Variables (n=52)
Resuscitation Protocol - AutoPulse TM Incorporated
Pit Crew Philosophy to Integration of AutoPulse TM  into Resuscitation Protocol ,[object Object],[object Object],[object Object],[object Object]
Deployment Sequence
Deployment Sequence
Deployment Sequence
IS IT VF/ PULSELESS VT? NO (ASYSTOLE/PEA)  YES * Restart  AutoPulse TM * Follow asystole/PEA Protocol * Give 2nd dose of adrenaline  * Restart  AutoPulse TM * Charge defib * Give 2nd dose of adrenaline * Stand clear * Deliver shock * CPR for 1 min * Follow VF protocol   SINUS RHYTHM     CHECK PULSE  Pulse present  * Do not restart   AutoPulse TM    Check BP    S tart inotropes   NO PULSE   Deployment Sequence
Summary ,[object Object],[object Object]
 
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Autopulse

  • 1. Advances in Automated CPR A/Prof Marcus Ong Consultant, Senior Medical Scientist & Director of Research Department of Emergency Medicine Singapore General Hospital Adjunct Associate Professor Duke-NUS Graduate Medical School Office of Research
  • 2. Chain of Survival Courtesy of Life Support Training Centre, Singapore General Hospital
  • 3.
  • 4. Aortic diastolic (red) and right atrial (yellow) pressures during CPR (2 ventilations in 4-second period)
  • 5. Chest Compressions and Coronary Perfusion Pressure CPP at 5:1 Ratio CPP at 15:2 Ratio
  • 6.
  • 7. Thumper Model 1007 Mechanical CPR System
  • 8. X-CPR (automatic simultaneous sternothoracic CPR, SST-CPR, device)
  • 9. Lund University Cardiopulmonary Assist System (LUCAS)
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  • 18. Utstein reporting template for data elements Resuscitation attempted N = 381 Resuscitation not attempted (pronounced dead on scene, DNR etc) N = 1256 Presumed cardiac etiology N =284 Non-cardiac etiology N = 255 LDB-CPR phase N= 284 STD-CPR phase N= 499 STD-CPR phase Absence of signs of circulation and/or considered for resuscitation (age  18) N= 1475 LDB-CPR phase Absence of signs of circulation and/or considered for resuscitation (age  18) N= 819 Resuscitation attempted N = 657 Presumed cardiac etiology N = 499 Device applied N= 210 Device not applied N= 74 (Reason missing =2) Not indicated N= 50 Not available N= 14 Mechanical failure N= 4 Inability to fit N= 4 Cease resuscitation N= 22 ROSC N= 20 En route N= 8
  • 19.
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  • 30. Relationship between response time and survival to hospital discharge by phases for patients not witnessed by EMS 1/37 (2.7, 0.5 – 13.8) 3/103 (2.9, 1.0 - 8.2) > 8 15/185 (8.1, 5.0 – 13.0) 6/323 (1.9, 0.9 - 4.0) <8 Survival N (%, 95% CI) Survival N (%, 95% CI) Ambulance response time interval [min] LDB-CPR STD-CPR
  • 31. Survival to hospital discharge for manual and A-CPR stratified by 3 month periods
  • 32.
  • 33.  
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  • 35.
  • 36. Interruptions to CPR during device deployment
  • 37. QCPR variables (1 st 5 mins) after Autopulse Implementation 0.50 (0.28) 0.25 (0.13) NFR 150.82 (83.89) 76.29 (39.92) NFT 34.76 (23.98) 39.78 (24.26) Compression/min 102.93 (28.00) 128.00 (14.19) Compression rate/min 34.86 (21.49) 33.26 (20.19) Compression ratio AutoPulse (n=29) Manual CPR (n=23) Variables (n=52)
  • 38. Resuscitation Protocol - AutoPulse TM Incorporated
  • 39.
  • 43. IS IT VF/ PULSELESS VT? NO (ASYSTOLE/PEA) YES * Restart AutoPulse TM * Follow asystole/PEA Protocol * Give 2nd dose of adrenaline * Restart AutoPulse TM * Charge defib * Give 2nd dose of adrenaline * Stand clear * Deliver shock * CPR for 1 min * Follow VF protocol SINUS RHYTHM  CHECK PULSE Pulse present * Do not restart AutoPulse TM  Check BP  S tart inotropes NO PULSE Deployment Sequence
  • 44.
  • 45.  
  • 47. Conference Secretariat: Tel: (65) 6 379 5261/ 6 379 5259 Fax: (65) 6 475 2077 Email: admin@ icem2010.org
  • 49. See You in Singapore!