Metrics of Mechanical Chest Compression Device Use in Out-of-hospital Cardiac Arrest

Overview

Journal J Am Coll Emerg Physicians Open

Publisher Elsevier

Specialty Emergency Medicine

Date 2021 Jan 4

PMID 33392525

Citations 3

Authors

Michael Levy

Karl B Kern

Dana Yost

Fred W Chapman

Bjarne Madsen Hardig

Affiliations

Soon will be listed here.

Abstract

Objective: The quality of cardiopulmonary resuscitation (CPR) affects outcomes from cardiac arrest, yet manual CPR is difficult to administer. Although mechanical CPR (mCPR) devices offer high quality CPR, only limited data describe their deployment, their interaction with standard manual CPR (sCPR), and the consequent effects on chest compression continuity and patient outcomes. We sought to describe the interaction between sCPR and mCPR and the impact of the sCPR-mCPR transition upon outcomes in adult out-of-hospital cardiac arrest (OHCA).

Methods: We analyzed all adult ventricular fibrillation OHCA treated by the Anchorage Fire Department (AFD) during calendar year 2016. AFD protocols include the immediate initiation of sCPR upon rescuer arrival and transition to mCPR, guided by patient status. We compared CPR timing, performance, and outcomes between those receiving sCPR only and those receiving sCPR transitioning to mCPR (sCPR + mCPR).

Results: All 19 sCPR-only patients achieved return of spontaneous circulation (ROSC) after a median of 3.3 (interquartile range 2.2-5.1) minutes. Among 30 patients remaining pulseless after sCPR (median 6.9 [5.3-11.0] minutes), transition to mCPR occurred with a median chest compression interruption of 7 (5-13) seconds. Twenty-one of 30 sCPR + mCPR patients achieved ROSC after a median of 11.2 (5.7-23.8) additional minutes of mCPR. Survival differed between groups: sCPR only 14/19 (74%) versus sCPR + mCPR 13/30 (43%), = 0.045.

Conclusion: In this series, transition to mCPR occurred in patients unresponsive to initial sCPR with only brief interruptions in chest compressions. Assessment of mCPR must consider the interactions with sCPR.

Citing Articles

Injuries associated with mechanical chest compressions and active decompressions after out-of-hospital cardiac arrest: A subgroup analysis of non-survivors from a randomized study.

Petrovich P, Berve P, Barth-Heyerdahl Roald B, Kongsgard H, Stray-Pedersen A, Kramer-Johansen J Resusc Plus. 2023; 13:100362.

PMID: 36798487 PMC: 9926013. DOI: 10.1016/j.resplu.2023.100362.

Finding the right pace: Addressing the transition from manual to mechanical compression devices for out-of-hospital cardiac arrest.

Cisewski D, Caputo N J Am Coll Emerg Physicians Open. 2021; 1(6):1222-1223.

PMID: 33392526 PMC: 7771798. DOI: 10.1002/emp2.12274.

Metrics of mechanical chest compression device use in out-of-hospital cardiac arrest.

Levy M, Kern K, Yost D, Chapman F, Hardig B J Am Coll Emerg Physicians Open. 2021; 1(6):1214-1221.

PMID: 33392525 PMC: 7771774. DOI: 10.1002/emp2.12184.

References

Hostler D, Everson-Stewart S, Rea T, Stiell I, Callaway C, Kudenchuk P . Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial. BMJ. 2011; 342:d512. PMC: 3033623. DOI: 10.1136/bmj.d512. View

Yost D, Phillips R, Gonzales L, Lick C, Satterlee P, Levy M . Assessment of CPR interruptions from transthoracic impedance during use of the LUCAS™ mechanical chest compression system. Resuscitation. 2012; 83(8):961-5. DOI: 10.1016/j.resuscitation.2012.01.019. View

Levy M, Kern K, Yost D, Chapman F, Hardig B . Metrics of mechanical chest compression device use in out-of-hospital cardiac arrest. J Am Coll Emerg Physicians Open. 2021; 1(6):1214-1221. PMC: 7771774. DOI: 10.1002/emp2.12184. View

Wik L, Olsen J, Persse D, Sterz F, Lozano Jr M, Brouwer M . Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation. 2014; 85(6):741-8. DOI: 10.1016/j.resuscitation.2014.03.005. View

Schmidbauer S, Herlitz J, Karlsson T, Axelsson C, Friberg H . Use of automated chest compression devices after out-of-hospital cardiac arrest in Sweden. Resuscitation. 2017; 120:95-102. DOI: 10.1016/j.resuscitation.2017.09.004. View

Andersen L, Grossestreuer A, Donnino M . "Resuscitation time bias"-A unique challenge for observational cardiac arrest research. Resuscitation. 2018; 125:79-82. PMC: 6080954. DOI: 10.1016/j.resuscitation.2018.02.006. View

Perkins G, Lall R, Quinn T, Deakin C, Cooke M, Horton J . Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. Lancet. 2014; 385(9972):947-55. DOI: 10.1016/S0140-6736(14)61886-9. View

Levy M, Yost D, Walker R, Scheunemann E, Mendive S . A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation. Resuscitation. 2015; 92:32-7. DOI: 10.1016/j.resuscitation.2015.04.005. View

Buckler D, Burke R, Naim M, MacPherson A, Bradley R, Abella B . Association of Mechanical Cardiopulmonary Resuscitation Device Use With Cardiac Arrest Outcomes: A Population-Based Study Using the CARES Registry (Cardiac Arrest Registry to Enhance Survival). Circulation. 2016; 134(25):2131-2133. DOI: 10.1161/CIRCULATIONAHA.116.026053. View

10.

Wang P, Brooks S . Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev. 2018; 8:CD007260. PMC: 6953326. DOI: 10.1002/14651858.CD007260.pub4. View

11.

Youngquist S, Ockerse P, Hartsell S, Stratford C, Taillac P . Mechanical chest compression devices are associated with poor neurological survival in a statewide registry: A propensity score analysis. Resuscitation. 2016; 106:102-7. DOI: 10.1016/j.resuscitation.2016.06.039. View

12.

Reynolds J, Grunau B, Rittenberger J, Sawyer K, Kurz M, Callaway C . Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest: Implications for Prolonging or Terminating Resuscitation. Circulation. 2016; 134(25):2084-2094. PMC: 5173423. DOI: 10.1161/CIRCULATIONAHA.116.023309. View

13.

Axelsson C, Jimenez Herrera M, Fredriksson M, Lindqvist J, Herlitz J . Implementation of mechanical chest compression in out-of-hospital cardiac arrest in an emergency medical service system. Am J Emerg Med. 2013; 31(8):1196-200. DOI: 10.1016/j.ajem.2013.05.002. View

14.

Krarup N, Terkelsen C, Johnsen S, Clemmensen P, Olivecrona G, Hansen T . Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study. Resuscitation. 2010; 82(3):263-9. DOI: 10.1016/j.resuscitation.2010.11.003. View

15.

Rubertsson S, Lindgren E, Smekal D, Ostlund O, Silfverstolpe J, Lichtveld R . Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial. JAMA. 2013; 311(1):53-61. DOI: 10.1001/jama.2013.282538. View

16.

Hayashida K, Tagami T, Fukuda T, Suzuki M, Yonemoto N, Kondo Y . Mechanical Cardiopulmonary Resuscitation and Hospital Survival Among Adult Patients With Nontraumatic Out-of-Hospital Cardiac Arrest Attending the Emergency Department: A Prospective, Multicenter, Observational Study in Japan (SOS-KANTO [Survey of.... J Am Heart Assoc. 2017; 6(11). PMC: 5721797. DOI: 10.1161/JAHA.117.007420. View

17.

Zeiner S, Sulzgruber P, Datler P, Keferbock M, Poppe M, Lobmeyr E . Mechanical chest compression does not seem to improve outcome after out-of hospital cardiac arrest. A single center observational trial. Resuscitation. 2015; 96:220-5. DOI: 10.1016/j.resuscitation.2015.07.051. View

18.

de Graaf C, Donders D, Beesems S, Henriques J, Koster R . Time to Return of Spontaneous Circulation and Survival: When to Transport in out-of-Hospital Cardiac Arrest?. Prehosp Emerg Care. 2020; 25(2):171-181. DOI: 10.1080/10903127.2020.1752868. View

19.

Grunau B, Reynolds J, Scheuermeyer F, Stenstom R, Stub D, Pennington S . Relationship between Time-to-ROSC and Survival in Out-of-hospital Cardiac Arrest ECPR Candidates: When is the Best Time to Consider Transport to Hospital?. Prehosp Emerg Care. 2016; 20(5):615-22. DOI: 10.3109/10903127.2016.1149652. View

20.

Esibov A, Banville I, Chapman F, Boomars R, Box M, Rubertsson S . Mechanical chest compressions improved aspects of CPR in the LINC trial. Resuscitation. 2015; 91:116-21. DOI: 10.1016/j.resuscitation.2015.02.028. View