Advances in Automated CPR A/Prof Marcus Ong Consultant, Senior Medical Scientist & Director of Research Department of Emergency Medicine Singapore General Hospital

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

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

7. Thumper Model 1007 Mechanical CPR System

8. X-CPR (automatic simultaneous sternothoracic CPR, SST-CPR, device)

9. Lund University Cardiopulmonary Assist System (LUCAS)

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

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

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

40. Deployment Sequence

41. Deployment Sequence

42. Deployment Sequence

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

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