mechanical cpr: evidence and issues
TRANSCRIPT
Mechanical CPR Devices
Evidence And Issues.
Dr Hassan Zahoor. ED SCGH.
Chain Of survival
Importance Of Good Quality CPR
Manual CPR Mechanical CPR
• Physical abilities , and fatigue
• Focus on several tasks
• Poor quality CPR while patient transportation.
• Interruptions during movement of patients
• Maintaining a proper rate of CPR.
• Best manual CPR produces coronary and CPP that is 30 % of normal.
• Provides consistent rate and depth of compressions.
• Increase brain flow by as much as 60 % in pigs.
• Adequate coronary pressures 15 mmgh in pigs and 19 in humans.
• Can provide compressions during PCI and is reasonable to use.
History And Current Trend
• Originally performed on Dogs (successfully) around 50 years ago.
• Reports of M-CPR ( (Piston Based Devices) in victoria in 70s.
• Later Piston systems showed no mortality benefit in humans (but some hemodynamic benefit).
• LUCAS 2
• Sec Generation, fully battery operated automatic CPR device.
• Compact, light weight, portable.
• EMS services, St johns ambulance, hospitals have mostly this device.
• Other devices like Action decompression devices, LDB are also available.
Evidence
• Evidence is mixed, not very supportive.
• Definitely needs more research.
• Good outcomes in certain situations.
LINC Trial JAMA. 2014;
PARAMEDIC TRIAL
Lancet 2014.
Multicenter RCT of about 2500 patients divided into M-CPR and conventional groups.
No difference in survival of patients in M-CPR and conventional CPR groups.
• RCT of 4500 patients with half exposed to LUCAS-2 and half to manual CPR.
• No evidence of improvement in 30 day survival of LUCAS 2 group patients.
Potential Harm From M- CPR
CHEER Trial
CHEER Trial
Small, non blinded sample of 26 patients, both IHCA and OHCA.
Refractory VT or V Fib in , in patients with potentially reversible cause of arrest.
Mechanical CPR , therapeutic hypothermia ,and then ECMO , followed by intervention.
54 % survival to discharge with good neurological outcome.
Issues Identified.
• Mixed supportive evidence.
• Most of evidence is for OHCA
• Not enough to warrant introduction of M-CPR in resuscitation guidelines.
• worse outcome or increased injuries in some studies.
• Cost of these devices.
Potential Practical role
• Paramedics transferring patients
• Genuine role in selected number of patients.
• Suitable patients requiring ECMO , long CPR, and further intervention as in CHEER trial.
• Rural setting with lack of man power.
References
• https://ambofoam.wordpress.com/2014/10/23/mechanical-cpr-three-cheers-or-a-big-thumbs-down/
• http://www.resuscitationjournal.com/article/S0300-9572(14)00751-5/abstract
• http://link.springer.com/article/10.1007%2Fs12471-014-0617-x#page-1
• http://www.ncbi.nlm.nih.gov/pubmed/25277343
