mechanical vs manual chest compression in out of-hospital cardiac
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TRANSCRIPT
Ahed Al Najjar, FAHAFellow American Heart Association
Director, Life Support Training Center, KSU
Vic President of Jordan Association of EMS
AREMT EMS Board Director
United Nations – UNOPS EMS Consultant (previous)
• Survival from sudden cardiac arrest (SCA) is zero
percent if external chest compressions (CPR) are not
performed.
• Since the 1950s, when Dr. Peter Safar first described
the modern technique of pushing on the chest to
create blood flow, researchers have worked to
optimize manual compression depth and rate while
trainers have trained millions of people worldwide in
CPR.
• Along with automated external defibrillators and
basic airway management, CPR is considered a
fundamental component of basic life support (BLS) in
cardiac resuscitation.
Introduction
Background
• From the 1970s to the late 90s, much attention was
given to advance life support (ALS).
• However, complex and complicated techniques were
not improving survival rates.
• In 2005, the American Heart Association
recommended for cardiac arrest management:
– minimally interrupted chest compressions
– adequate depth and sufficient rate
– ensure full chest recoil
Manual Chest Compressions
• rescuer kneeling upright next to the
victim, using two outstretched arms
placed over the sternum, and bending
at the hips to create a downward force
• The rescuer returns back to an upright
position, releasing all pressure off the
chest.
This “duty cycle” is repeated at a rate of at least one
hundred times per minute, interrupted every 30
compressions to deliver a small volume of air to
ventilate the lungs.
Manual Chest Compressions
Challenges:
1. Size and weight of rescuer
– Adequacy of compressions
2. The training must be simple enough
to acquire quickly and retain.
Performing CPR is a task that is seldom practiced in real life
by the lay public; even professional rescuers perform CPR at
a much lower frequency than other procedures such as
measuring blood.
Manual Chest Compressions
Challenges:
3. Fatigue during CPR is a major factor.
4. Finally, trying to deliver effective manual chest
compressions during patient extrication and transport is
extremely difficult.
Mechanical Chest CompressionsThe device is an automated, portable, battery-powered
cardiopulmonary resuscitation device and subsequently
purchased and currently manufactured by ZOLL Medical
Corporation.
It is a chest compression device composed of a
constricting band and half backboard that is intended to
be used as an adjunct to CPR during advanced cardiac
life support by professional health care providers.
The device uses a distributing band to deliver the chest
compressions. In literature it is also known as LDB-CPR
(Load Distributing Band-CPR).
Chest compression devices
• As early as the 1960s, the “Thumper” made by Michigan
Instruments used an oxygen-powered piston on an adjustable
arm to deliver compressions.
Chest compression devices
• The Zoll Autopulse
– uses a load-distributing band that is
wrapped around the victim’s chest and
tightened rhythmically by an electrical
motor.
• Physio Control’s LUCAS
– pneumatic or electric
– compresses the chest with a piston
in a more compact configuration.
Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products,
models or manufacturers.
Chest compression devices
Advantages:
• Ensures improved blood flow (squeezes
the entire chest).
• Is fast, easy, and intuitive to start up and
use.
– it automatically calculates the size,
shape, and resistance of each
patient's chest.
• Functions as an "additional person”.
• Ensures clinical safety.
• Ensures rescuer safety during
transport.
Chest compression devices
Disadvantages:
• large-scale scientific studies have not shown
the effectiveness.
• Significant cost of devices.
• Costly replacement parts and maintenance
• It requires significant training and practice to
implement each device with minimal
interruption to CPR during a cardiac arrest
• Several cases have been reported where the
device has caused additional injury to patients
receiving compressions from the device
Study 1: Mechanical vs Manual CPR
• Out-of-hospital cardiopulmonary resuscitation with the
AutoPulseTM system: A prospective observational study with
a new load-distributing band chest compression device.
(Department of Anaesthesiology and Intensive Care Medicine, University
of Bonn, Bonn, Germany in 31 August 2006)
Human Hemodynamics Study: generated CPP was 33%
better than manual CPRAutoPulse tripled survival to hospital discharge
Study 2: Mechanical vs Manual CPR
• Mechanical CPR devices compared to manual CPR during out-
of-hospital cardiac arrest and ambulance transport: a
systematic review. (Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore,
Department of Emergency Medicine, Kaiser Permanente, Sacramento, CA, USA.,Department of Emergency System, Graduate School of Sport System, Kokushikan
University, Tokyo, Japan, Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan, Department of Emergency Medicine, William Beaumont
Hospital, Royal Oak, MI, USA, Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea)
Conclusion
• At this point, researchers neither recommend nor discount
the routine use of mechanical CPR devices in cardiac arrest.
• More research is needed.
• Better training and practice in deploying chest compression
devices may help improve arrest outcomes.
Class IIb Acceptable and useful. Fair to good
evidence provides support.