zoll autopulse presentation
TRANSCRIPT
AutoPulse®
Load-Distributing Band CPR
AutoPulse®
What it is?
• Automated chest compression device
• “Load-distributing band” (LDB) technology
What does it do?
• Chest compressions that humans can’t possibly do
• Consistent, uninterrupted (never gets tired)
• Moves more blood, more effectively
Consistent Compressions
• Each one the same
Custom Compressions
• Tailored to deliver 20% displacement to each patient
Safer Compressions• Load distribution = distributed force
AutoPulse Delivers…
AutoPulse Benefits
Patients• Increases chances of survival
Caregiver• Allows them to deliver patient care
• Free to deliver other important therapies
Organization• Helps save more lives
• Promotes “leading-edge” view
AutoPulse – Not Intended For
Traumatic injury
• Sudden physical injury
• Violence
AutoPulse compressions may Increase
Hemorrhaging, Resulting in Hypovolemia
Perfusion is the single most
important factor for successful
resuscitation
FACT:
Circulation is Critical for Survival
Provides oxygen to
preserve vital organ
function
Converts non-shockable
rhythms (asystole, PEA) to
shockable ones (VF, VT)
Peberdy MA et al. Resuscitation. 2003;58:297-308.
VF Changes Over Time
-0.4
-0.2
0
0.2
0.4
0.6
-0.4
-0.2
0
0.2
0.4
0.6
Onset of VF
5 Minutes VF
CPR and VF
-0.4
-0.2
0
0.2
0.4
0.6
-0.4
-0.2
0
0.2
0.4
0.6
5 Minutes of VF
After 3 Minutes of Effective CPR
Eftestol et al Circulation 2004;110;10-15
Coronary Perfusion and ROSC
Victims with CPP <15
mmHg do not achieve
ROSC.
The mean CPP with
manual compressions is
12.5 mmHg.
Coronary Perfusion Pressure
Predicts ROSC
Paradis NA et al. JAMA. 1990;263:1106-1113.
Coronary Perfusion and ROSC
A well perfused myocardium is more likely to
experience return of spontaneous circulation (ROSC)
Quality of CPR
Evidence and Effects
Guidelines 2010: CPR
Adequate rate of “at least 100/minute”
Compression [sternal] depth of “at least 2 inches (5 cm)”
Allowing complete chest recoil after each compression
Ventilation: 8 -10 breaths per minute
Minimizing interruptions in compressions
Avoiding excessive ventilations (8-10 breaths/minute)
Challenges to Effective CPR
Limits of sternal compressions
Poor quality compressions
• Inconsistent rate
• Poor depth
• Improper duty cycle
Harmful interruptions due to
• Clinician fatigue
• Patient movement
Incomplete release“…chest compressions were not
delivered half the time, and most
compressions were too shallow…”Lars Wik, MD et al. JAMA. 2005;293(1):299-304.
Manual CPR and Blood Flow
30% - 40% of normal flow
Manual CPR provides less than optimal blood flow to
the heart and brain
10% - 20% of normal flow
Kern KB Bailliere’s Clinical Anaesthesiology. 2000;14(3):591-609.
20
94%
72%
60%
38%
0%
20%
40%
60%
80%
100%
<10.0 10.1-20.0 20.1 - 30.0 >30.0
Sh
oc
k S
uc
ce
ss
Pre-Shock Pause (sec)
p=0.002
Edelson et al, Resuscitation. 2006; 71:147-145
Pauses
How Much Does It Matter?
Sure, Smart, Safe
21
Positioning Strategy
Load Distributing Band Mechanism
Three Points of Focus
The only mechanical CPR system to
show significant clinical benefits in
comparative human trials.Sure
Intelligence that optimizes compressions
for each patient.Smart
Effective compressions without the risk
of higher injury rates.Safe
Improved Vital Signs
Human Studies Show
Systolic BPs > 100 mmHg
SpO2 Values Consistently > 90%
Increased CO2 levels
Timerman et al. Resuscitation 61 (2004) 273–280
Swanson et al. Circulation 2008:118:S-767
Duchateaux et al. Intensive Care Med 101007/s00134-010-1784 Gonin et al. Rev des Samu 2005;27:152-3. Liu et al. Chinese Critical Care Medicine 2010 Nov;22(11):660-2.
Multiple comparative studies
demonstrated vital signs improve in
humans because the AutoPulse
drives superior blood flow.
Timerman et al. Resuscitation 61 (2004) 273–280
Swanson et al. Circulation 2008:118:S-767
Duchateaux et al. Intensive Care Med 101007/s00134-010-1784 Gonin et al. Rev des Samu 2005;27:152-3. Liu et al. Chinese Critical Care Medicine 2010 Nov;22(11):660-2.
Timerman et al. Resuscitation 61 (2004) 273–280
Swanson et al. Circulation 2008:118:S-767
Duchateaux et al. Intensive Care Med 101007/s00134-010-1784 Gonin et al. Rev des Samu 2005;27:152-3. Liu et al. Chinese Critical Care Medicine 2010 Nov;22(11):660-2.
Timerman et al. Resuscitation 61 (2004) 273–280
Swanson et al. Circulation 2008:118:S-767
Duchateaux et al. Intensive Care Med 101007/s00134-010-1784 Gonin et al. Rev des Samu 2005;27:152-3. Liu et al. Chinese Critical Care Medicine 2010 Nov;22(11):660-2.
Timerman et al. Resuscitation 61 (2004) 273–280
Swanson et al. Circulation 2008:118:S-767
Duchateaux et al. Intensive Care Med 101007/s00134-010-1784 Gonin et al. Rev des Samu 2005;27:152-3. Liu et al. Chinese Critical Care Medicine 2010 Nov;22(11):660-2.
Sure
Improved Coronary Perfusion
Human Study
CPP produced by Load
Distributing Band was 33% higher
than with sternal compressions.
Timerman S et al. Resuscitation. 2004;61:273-280.
AutoPulse drives CPP to levels
sufficient to achieve ROSC.
Paradis NA et al. JAMA. 1990;263:1106-1113.
*p=0.015
Sure
CPP drops quickly
when AutoPulse
compressions stop
Manual CPR
CPP returns after
several AutoPulse
compressions
AutoPulseAutoPulse
Human Hemodynamics Study
Timmerman S et al. Resuscitation. 2004;61:273-280.
Improved ROSC
AutoPulse consistently shows improved ROSC
rates compared to sternal compressions.Sure
Improved Survival to Discharge
Ong et al. Circulation 2010;122:A100Ornato J et al. JAMA. 2006;295(22):2629-2637.
Controlled trials in humans demonstrate the
AutoPulse improves survival.
1,011 patients
OR, 2.27; 95% CI, 1.11-4.77
783 patients
OR: 3.99; 95% CI, 1.06-15.02
Sure
IMPROVEMENT IMPROVEMENT
Individualized Compressions
Smart
AutoPulse delivers a 20%
anterior-posterior
compression for each
patient.
Accounts for patient-to-
patient variability
2-inch compression has different effects
on varying chest sizes.
Human Anatomies Differ
Force Adjusted to Chest Stiffness
Smart
The AutoPulse Load Sensor
Control system adjusts force to
insure the difficult [larger, stiffer]
patients get the correct
compression.
Designed to deliver target
compression on patients through
the 95th percentile for size and
stiffness.
Tomlinson AE, et al., Compression force-depth relationship during out-of hospital cardiopulmonary
resuscitation, Resuscitation 2006.07.017
The force required to deliver an adequate chest
compression can differ by 400 percent.
Human Chest Stiffness
Automatically Sized to Patient
Every patient gets a safe and effective
compression.Smart
Eliminates operator error
• No under compression
• No over compression
Minimizes risk of
chest injury
Ensures complete chest
release to optimize
circulation
Review Resuscitation Events
Debriefing of actual resuscitation
events can be a useful strategy to
improve future performance, Class IIa
AutoPulse & RescueNet® Code Review
The most comprehensive out-of-hospital
review system
• Both manual CPR and AutoPulse
compressions
• Plus shock, monitor, intervention data
Smart
Force Distributed Safely
AutoPulse delivers twice the force of
manual compressions.
Force dispersed over large surface area
of the LifeBand.
More effective compressions
without risk of higher injury rates
Safe
Safe
Operates below Injury Threshold
If the amount of pressure applied to chest equals 6 pounds per
square inch, the risk of chest compression injuries climbs.1
1.Knoell CK. Thoracic response to blunt frontal loading SH. Published by
Society of Automotive Engineers, Inc. 1976.
The pressure applied to the chest with AutoPulse
is well below the injury threshold.
Safe
Detects and Alerts Un-Safe Situations
Automatic detection of
LifeBand out of starting
position
Unexpected patient
movement
Incorrect patient alignment
The AutoPulse minimizes patient injury by halting
compression should the patient or LifeBand move to
an unsafe position.
In Summary
The only mechanical CPR system to
show significant clinical benefits in
human comparative trialsSure
Smart
Effective compressions without the risk
of higher injury ratesSafe
Intelligence that optimizes compressions
for each patient.