A talk by David Anderson from TBS24

1. MANUAL PRESSURE
AUGMENTATION
David Anderson
MStJ MBChB FCICM
Medical Director - Ambulance Victoria
Intensivist – The Alfred ICU
Adj. Assoc.Prof. - Monash Paramedicine
@expensivecare
In Out of Hospital Cardiac Arrest
Lead Investigators:
Alex Voskoboinik
Ziad Nehme
Dion Stub

3. 227,444 km2
41,285 km2
1 million calls/year
5000 paramedics
7800 cardiac arrests/year
500 critical care paramedics

5. VACAR 2022

6. VACAR 2022
*Average Patient:
• 64 years old
• Cardiac aetiology
• Arrests at home
• 9.2 min response time
• Bystander witnessed
• Bystander CPR
• Shocked first by paramedics
Probability of Surviving Cardiac Arrest
for the ‘Average’ Patient*

8. Young, Anaes & ICM, 2021

9. Trans-thoracic Impedance
Ramirez, PACE, 2016

10. Manual Pressure Augmentation

12. Why use MPA?
Squara, Heart Rhythm, 2021

13. Why use MPA?
Ramirez, Europace, 2019

14. MPA for AF in Obese Patients
Voskoboinik, JCE, 2019
Paddles > Pads
30% DCCV success rate
MPA > Paddles
80% MPA success rate
VC No difference

15. Nguyen, Europace, 2023

16. “Alex - Great study
in AF….
Imagine what we
could do for patients
in VF/VT”

17. Potential Benefits of MPA in VF/VT
↓ Lung volume
↓ Transthoracic Impedance
↑ Current to heart

18. Routinely used in many hospitals for
cardioversion in AF
No reported serious adverse events in clinical
practice or literature.
Is MPA safe?

20. Stephens, Resus Plus, 2022

21. Voskoboinik, Resus, 2022
59Ω
1
60Ω
2
49Ω
+MPA
3
No perceptible current felt by paramedics

22. The AUGMENT-VA Trial
P Adults in VF or VT
I MPA
C Standard ACLS
O Survival to Hospital
Discharge

23. Standard care (BLUE TEAM)
How did we randomize?
MPA
Standard
MPA (RED TEAM)

24. How do we perform MPA?
Clenched fist
Heel of palm

26. Paramedic Experience
96 Paramedics surveyed
Perceptible current?: 1/96
Would you use it again?: 96/96

27. Recruitment…😬

28. The Age, 2023

29. Image: National Museum of American History

31. Cheskes, NEJM, 2022 Richardson, SJTREM, 2023
Moore, Resusc, 2022
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32. Questions?
david.anderson@monash.edu
@expensivecare