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Mechanical CPR Devices - The current evidence
Mechanical CPR devices were developed to address the problems of early fatigue and declining quality of manual chest compressions during prolonged CPR. They work using either a pneumatic piston or load distributing band to provide uninterrupted, consistent chest compressions. Current evidence from meta-analyses shows that mechanical CPR does not provide benefits over manual CPR in terms of ROSC or long-term survival. However, mechanical CPR may be useful in situations where high-quality manual compressions are difficult or when rescuers need to be protected, such as during transfers or prolonged resuscitation efforts. Guidelines do not recommend routine use of mechanical CPR over manual CPR.
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Mechanical CPR Devices - The current evidence
- 1.
- 2. Objectives ✤ Why theywere developed. ✤ How they work. ✤ Current evidence. ✤ When they are useful. ✤ When they are not so useful. ✤ What next?
- 3. 01 Why? ✤ 15000 OHCAper year ✤ Only roughly 10% of OHCA will survive ✤ Most important factors Early defibrillation Early, high quality and uninterrupted chest compressions.
- 4. 01 Chest Compressions ✤ High quality1,2,3,4 ✤Uninterrupted5
- 5. 01 Mechanical CPR Pneumatic Piston ✤LUCAS (Lund University Cardiac Assist System) ✤ Michigan Thumper
- 6. 01 Mechanical CPR Load distributingband ✤ Zoll Autopulse
- 7. 01 Mechanical CPR ✤ LUCAS2 How to use.
- 8. ✤ 2015 ✤ Systematicreview ✤ RCT’s ✤ Over 10000 patients ✤ OHCA: atraumatic ✤ Comparing manual to mechanical CPR
- 9. Autopulse ✤ ASPIRE ✤ CIRC LUCAS ✤Smekal et al. ✤ LINC ✤ PARAMEDIC
- 10. ASPIRE 2006 -Autopulse ✤ USA/Canada ✤ Cluster RCT ✤ 767 patients ✤ Trial terminated early ✤ Discharge from hospital Manual 9.9% Autopulse 5.8%
- 11. CIRC 2014 -Autopulse ✤ USA/Europe ✤ Multi-centre RCT. ✤ 4753 patients. ✤ Survival hospital discharge Autopulse 9.4% Manual 11% Odds ratio 1.06
- 12. LINC 2014 -LUCAS ✤ UK/Sweden/Netherlands ✤ Multi-centre RCT. ✤ 2589 patients. ✤ Survival 4 hours Manual 23.7% LUCAS 23.6%
- 13. PARAMEDIC 2015 -LUCAS ✤ UK ✤ Multi-centre cluster RCT ✤ 4471 patients. ✤ Survival 30 days Manual 7% LUCAS 6%
- 14. Meta-analysis ✤ Mechanical CPRshowed no advantage for ROSC Survival to discharge Survival with CPC 1 or 2
- 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. Current Guidelines ✤ ANZCOR ANZCORsuggests 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. 01 When is it useful? ✤Limited rescuers ✤ Transfers ✤ Prolonged CPR ✤ PCI6,7,8 ✤ ECMO9
- 18. 01 When are they notso useful? ✤ Fat/big ✤ Skinny ✤ Kids ✤ Trauma ✤ Poor placement
- 19. 01 What next? ✤ FurtherResearch Early use of mechanical CPR In hospital use
- 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.