MECHANICAL CHEST COMPRESSION DEVICES. Erica Simon, DO, MHA Military EMS & Disaster Medicine Fellow SAUSHEC

Transcription

1 MECHANICAL CHEST COMPRESSION DEVICES Erica Simon, DO, MHA Military EMS & Disaster Medicine Fellow SAUSHEC

2 Disclaimer The view(s) expressed herein are those of the author and do not reflect the official policy of position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army, the Department of Defense, or the U.S. Government. No disclosures.

3 Objectives History Devices Data Parsons I, Cox A, Rees P. Military application of mechanical CPR devices: a pressing requirement? J R Army Med Corps Apr 6 [epub ahead of print].

4 History Spectrum Health. Butterworth Hospital. Accessed 23 June Available from: Michigan Instruments. Our History. Accessed 23 June Available from: Michigan Instruments. Our History. Accessed 23 June Available from:

5 Devices Mechanism: Pneumatic Piston Delivers American Heart Association Compliant CPR Michigan Instruments. CPR Machine Models. Accessed 23 June Available from: com/automatic-mechanical-cpr-machines/ Limited Data: Single Center Studies: Hemodynamic improvement vs. manual CPR No mortality benefit

6 Devices Mechanism: Pneumatic or Battery-Powered Piston Delivers American Heart Association Compliant CPR Lund University Cardiac Assist System (LUCAS ) Contraindications to use: 5 Patient too small Patient > 170 kg Pregnant females Parsons I, Cox A, Rees P. Military application of mechanical CPR devices: a pressing requirement? J R Army Med Corps Apr 6 [epub ahead of print].

7 Devices Mechanism: Battery-powered Load Distributing Band Delivers American Heart Association Compliant CPR Contraindications: 6 Age < 18 Zoll AutoPulse Leader Healthcare. Zoll AutoPulse Cardiopulmonary Resuscitation System. Accessed 24 June Available from:

8 Data on Manual CPR Aufderheide T. Mechanical CPR. Accessed 24 June Available from: Reference contains data from: Steill I, Brown S, Chritenson J, et al. What is the role of chest compression depth during out-of-hosptial cardiac arrest resuscitation. Crit Care Med. 2012; 40(4): Idris A, Guffey D, Aufderheide T, et al. Relationship between chest compression rates and outcomes from cardiac arrest. Circulation. 2012; 125(24)

9 Data on Mechanical CPR Simulated Cardiac Arrest: Quality of CPR delivered is better with the LUCAS as compared to manual CPR: Porcine Models: Hemodynamics are improved with LUCAS CPR and AutoPulse CPR:

10 Does this translate to improved patient outcomes? LUCAS 2014 LINC Trial (Multicenter) 10 Manual CPR (n = 1289) vs. LUCAS (n=1300) Primary: 4 Hour Survival (23.7% vs. 23.6%, p = 0.99) Secondary: 6 Month Survival with CPC 1 or 2 (8.5% vs. 7.6%; risk difference 0.86%; 95% CI -1.2% to 3.0%) Findings = No significant difference in outcomes 2015 PARAMEDIC Trial (Cluster RCT) 11 Manual CPR (n=2819) vs. LUCAS (n=1652) Primary: 30 Day Survival (7% vs. 6%, OR 0.86%; 95% CI ) Findings = No significant difference in outcome

11 Does this translate to improved patient outcomes? AutoPulse 2010 ASPIRE (3 Centers, Block Randomization) 12 Manual CPR vs. AutoPulse Primary: Four Hour Survival Secondary: Survival to Hospital Discharge Findings: Study Discontinued (n=1071, protocol change at one center: AutoPulse four hour survival 19% 4%) 2011 CIRC (Randomized, Unblinded, Sequential Trial) 13 Manual CPR (n=2132) vs. AutoPulse (n=2099) Primary: Survival to Hospital Discharge (11.0% vs. 9.4%) Secondary: ROSC (32.3% vs. 28.6%), 24 Hour Survival (25.0% vs. 21.8%) Findings: Equivalent (Adjusted odds 1.06; 95% CI )

12 What does the AHA say? Piston Devices (The Thumper & LUCAS ) Load-Distributing Band (AutoPulse ) American Heart Association. Part 6: Alternative Techniques and Ancilliary Devices for Cardiopulmonary Resuscitation. Accessed 24 June Available from:

13 Are there additional findings since 2015? Largest Systematic Review and Meta-Analysis to Date: 12 Trials (9 Out-of-hospital, 3 In-hospital) 8 RCTs, 3 Phased Prospective Cohorts, 1 Descriptive Controlled Trial (n=11,162) 5 LUCAS, 4 AutoPulse, 3 Thumper Findings: Manual chest compressions superior to mechanical chest compressions for achieving ROSC (RR 0.71; 95% CI in-hospital; RR 0.87; 95% CI out-of-hospital) In-hospital studies demonstarting relative harm in terms of survival to hospital discharge with mechanical compression (RR 0.54; 95% CI ) Six Trials reporting CPC scores: CPC score of 1 or 2 at discharge: no significant difference (RR 1.11; 95% CI ).

14 Closing Thoughts So, why do we naturally like the idea of mechanical CPR? Allows first responders to perform other interventions Provides quality CPR Minimizes time between defibrillations Minimizes time off the chest Reduces fatigue Maybe not for peds

15 References 1. McDonald J. Systolic and mean arterial pressures during manual and mechanical CPR in humans. Ann Emerg Med. 1982;(11)6: Ward K, Menegazzi J, Zelenak R, et al. A comparison of chest compressions between mechanical and manual CPR by monitoring end-tidal PCO2 during human cardiac arrest. Ann Emerg Med. 1993; 22(4): Taylor G, Rubin R, Tucker M, et al. External cardiac compression. A randomized comparison of mechanical and manual techniques. JAMA. 1978; 240(7): Dickson E, Verdile V, Schneider R, et al. Effectiveness of chest compressions in out-of-hospital cardiac arrest resuscitation: A pilot study. Am J Emerg Med. 1998; 16(3): Jolife AB. LUCAS External Cardiac Compressor. Instructions for Use. Accessed 24 June Available from: 6. Zoll Autopulse. Produce Manual. Accessed 24 June Available from: 7. Putzer G, Braun P, Zimmermann A. LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue-a prospective, randomized, cross-over manikin study. Am J Emerg Med. 2013; 31(2): Steen S, Liao Q, Pierre L, et al. Evauation of LUCAS, a new device for automatic mechanical compresson and active decompression resuscitation. Resuscitation. 2002; 55(3): Halperin H, Paradis N, Ornato J, et al. Cardiopulmonary resuscitation with a novel chest compression device in a porcine model of cardiac arrest: improved hemodynamics and mechanisms. J Am Coll Cardiol. 2004; 44(11): Rubertsson S, Lindgren E, Smekal D, et al. Mechanical chest compressions and simultaneous defibrillation vs. conventional cardiopulmonary resuscitation in out-of hospital cardiac arrest: the LINC randomized trial. JAMA. 2014; 311(1) Perkins G, Lall R, Quinn T, et al. Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised control trial. Lancet. 2015; 385(9972): Paradis N, Young G, Lemeshow S, et al. Inhomogeneity and temporal effects in AutoPulse Assisted Prehospital International Resuscitation an exception from consent trial terminated early. Am J Emerg Med. 2010; 28(4): Lerner E, Persse D, Souders C, et al. Design of the Circulation Improving Resuscitation Care Trial: a new state of the art design for out-of-hospital cardiac arrest research. Resuscitation. 2011; 82(3):