The Merits of Mechanical CPR

Transcription

1 The Merits of Mechanical CPR Experiences with LUCAS Mark D. Frank

2 Incidenz of sudden cardiac arrest - in Europe ca humans p.a. - approx are dying - in Germany approx p.a. - ROSC 23.8% (10 50%) - Really only 2 10% (without neurological defizite CPC 1-2) - main cause is an acute Coronary syndrom (AMI) ca p.a. - since 30 years no changing in survival rates Sasson C et al. Circulation 2009 ( Patienten)

3 Circulation Patients Since 30 years nearly constant results

4 During a soccer game Miklos Feher from Benfica Lissabon was dying, because of sudden cardiac arrest. The conventional CPR was not succesful.

5 ERC Guidelines 2010 Main intention: Reducing the No Flow Time 100 / min 5-6 cm depht

6 Importance of No Flow Time

7 All You need is flow! Editorial 81 (2010) Kjetil Sunde Cath- Lab Immediately Transport

8 % of patients w/ RO Coronary Perfusion Pressure < 15 mmhg does not achieve Return of Spontaneous Circulation 90% 80% n = % 70% 60% 50% 46% 40% 30% 20% 10% 0% 0% < >25 CPP (mm Hg) Paradis NA et al. JAMA 1990

9 Reducing the No Flow Time Performance in reality Implementing the guidelines into practical work Code Stat; Physio Control

10 Circumstances in Realitäty Time pressure less space to work less light different teams prior diseases Adipositas Aspiration Caregivers Equipment Affecting Quality of CPR

11 What is a good target? Reduction of stress for the medical team Focus on the patients problem Step back and realize what the patient needs

12 Diagnostic and Treatment of Patients with OHCA, IHCA Daily Routine?

13 Equipement Equipement Algorithm Algorithmus (Plan) Training Training Experience Erfahrung

14 Comression depht No Flow Ratio Only 50 % of the teams reached the Requirements of the guidelines

15 Mechanical Resuscitation: LUCAS

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17 Mechanical Resuscitation: LUCAS LUCAS 100 Patients, no control group ROSC increased Steen S et al. Resuscitation Patients with manual CPR 150 Patients with LUCAS CPR ROSC significant increased Maule et al. Urgences and Accueil Injuries according LUCAS vs manual similar (16/26 Pat. Autopsie) Smekal et al. Resuscitation 2009 Many case reports, case series, non randomised trials LINC Trial (2500 pat. until 2011)

18 Increased cortical cerebral blood flow with LUCAS Baseline 100% n = 14 pigs P= P= % 40% LUCAS Manual Mean cerebral flow Endtidalt CO2 S. Rubertsson Resuscitation 2005

19 Outcomes [%] Mechanical CPR Manual CPR P-Value 4 hour survival >.99 ROSC Survival to discharge from ICU with CPC 1-2 Survival to Hospital discharge with CPC Month Survival with CPC CPC = Cerebral Performance Category

20 The LINC study protocol

21 n = 23 Outcomes LUCAS CPR Manual CPR P-Value Correct chest compressions During Flight [%] < Chest compression depth [%] < Pressure point [%] < Pressure release [%] Time to first Defibrillation [sec] < 0.001

22 Statement from the Swiss Resuscitation Council Notes for worsen neurological outcome and survival rate

23 No injuries: 42.1 vs 55.3

24 2012, 20:39

25 currently no evidence 2014

26 Innovation or Nonsense

27 Experience and practical Routine?? LOE 8: Grandfather- Rule

28 Implementation of LUCAS in Dresden, Germany Results cases of emergency from 1/ /2007 CPR in 724 cases (100 LUCAS) 67.3% male mean age females 73 Y, male 65 Y [1 Month - 100Y] mean rescue time 6.1 Min [0-24 min] 26 LUCAS 1 devices prehospital

29 Initial Rythm Asystolie PEA VF Sonst Frank MD, Andrä L, Haacke W et al. Intensivmed. 2008

30 First Results with regard to LUCAS Survivor Using LUCAS Admission to Hospital CPR during Transport ROSC at Hospital Frank et al. ICEM 2010

31 LUCAS Outcome?? Which Patients received LUCAS CPR? What are we calling a LUCAS CPR? Time slot to initiate LUCAS Abortion of CPR after doctor arrived on scene Pat provision was found during CPR Prior incurable disease Disability for dicision making- Transport with LUCAS

32 LUCAS 1

33 Reducing the No Flow Time Analysis every 2 Minutes? LUCAS 2

34 Learning curve First clinical data in Dresden miserable Increase of transports with ongoing CPR (2 x Rigor Mortis) Displacement of required decision making into the Hospital Positiv course in following years Which Patients have really a benefit? LUCAS CPR approx. 42 % in 2012

35 Learning curves regarding LUCAS ? ROSC ROSC-L Data evaluation in progress

36 et Carbon Dioxide during CPR 3 Carbondioxide [kpa] 2,5 n=22 2 1,5 manually Lucas 1 n=78 0, min 3-4 min 5-6 min 7-8 min 8-10 min 15 min 30 min Time [min] Data evaluation in progress

37 Hauptproblem Carbon Dioxide Case 1 Axelson et al. Resuscitation 2009 ( 126 Patients increasing of et CO 2 )

38 Transport with LUCAS we are resuscitating everyone?

39 An Option Pat. with acute coronary syndrome OHCA - CPR Transport with LUCAS Catheter Lab. ROSC Case 2

40 Case 3

41 Special Situations - multiple Trauma - Hypothermia - Intoxication - Thrombolysis in cardiac arrest - Transport with ongoing CPR - Others Advantage or Disadvantage???

42 Case 4 Car vs Bus, Pat trapped in the car, severe thoracic trauma, Cardiac arrest, CPR during transport and in ER

43 Fallbericht Case 5 Thoracic stab wound, CPR- ROSC, LUCAS CPR, Transport

44 Motorcycle accident, OHCA, Bystander CPR continuance with LUCAS Case 6

45 Case 7

46 Fall 1 Case 8

47 7 Accident; pat under vehicle Severe hipp injury- OHCA 1 - permissive Hypotension 2 - LUCAS 3 - ROTEM 1 5 coagulation factors 6 - Level I 7 - Team Case 10

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49 Manual CPR, Child 9 Y Case 11 OHCA cause unknown, Transport with ongoing CPR 1h to Hospital

50 Quality of CPR Training and CRM

51 Keep the overview

52 4 eyes will see more

53 Only together we can be successful

54 Teamwork

55 Presently there is no scientific evidence Conclusion LUCAS the endtidal Carbondioxide is increasing during LUCAS CPR and demonstrates good perfusion Injuries associated to LUCAS are possible like manuall CPR Transportation with ongoing CPR seems to be effective with LUCAS and is an option in several conditions LUCAS is not for relocate decisions into Hospital The use of LUCAS needs education and training to be more efficient The Quality of CPR Actions are essential (With and without mechanical Devices)

56 Foto: M. Frank

57 Afrika 2009

58 Point of View Marius Müller 4