Perkins, Gavin D., Brace, Samantha J. and Gates, Simon. (2010) Mechanical chest-compression devices: current and future roles. Current Opinion in Critical Care, Vol.16 (No.3). pp. 203-210. ISSN 1070-5295

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Abstract

Purpose of review: It is recognised that the quality of CPR is an important predictor of outcome from cardiac arrest yet studies consistently demonstrate that the quality of CPR performed in real life is frequently sub-optimal. Mechanical chest compression devices provide an alternative to manual CPR. This review will consider the evidence and current indications for the use of these devices. Recent findings: Physiological and animal data suggest that mechanical chest compression devices are more effective than manual CPR. However there is no high quality evidence showing improved outcomes in humans. There are specific circumstances where it may not be possible to perform manual CPR effectively e.g. during ambulance transport to hospital, en-route to and during cardiac catheterisation, prior to organ donation and during diagnostic imaging where using these devices may be advantageous. Summary: There is insufficient evidence to recommend the routine use of mechanical chest compression devices. There may be specific circumstances when CPR is difficult or impossible where mechanical devices may play an important role in maintaining circulation. There is an urgent need for definitive clinical and cost effectiveness trials to confirm or refute the place of mechanical chest compression devices during resuscitation.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	CPR (First aid), Cardiac arrest -- Treatment, Critical care medicine -- Research, Emergency medicine -- Research, Medical instruments and apparatus
Journal or Publication Title:	Current Opinion in Critical Care
Publisher:	Lippincott Williams & Wilkins
ISSN:	1070-5295
Date:	June 2010
Volume:	Vol.16
Number:	No.3
Page Range:	pp. 203-210
Identification Number:	10.1097/MCC.0b013e328339cf59
Status:	Not Peer Reviewed
Access rights to Published version:	Restricted or Subscription Access
Funder:	Great Britain. Dept. of Health (DoH)
References:	1 Atwood C, Eisenberg MS, Herlitz J, et al. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 2005; 67:75-80. 2* Lloyd-Jones D, Adams RJ, Brown TM, et al. Executive summary: heart disease and stroke statistics 2010 update: a report from the American heart association. Circulation 2010; 121:948-954. Summary of epidemiology of cardiac arrest in the United States. 3** Sasson C, Rogers MA, Dahl J, et al. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010; 3:63-81. This is a systematic review and meta-analysis of key predictors of survival from out-of-hospital cardiac arrest drawn from 79 studies involving 142 740 patients. Witnessed arrest; bystander CPR and ventricular fibrillation/ventricular tachycardia and or achieved return of spontaneous circulation. The number needed to treat for bystander CPR to save one life was between 24 and 36 depending on baseline survial rates. 4 Edelson DP, Abella BS, Kramer-Johansen J, et al. Effects of compression depth and preshock pauses predict defibrillation failure during cardiac arrest. Resuscitation 2006; 71:137-145. 5 Kramer-Johansen J, Myklebust H, Wik L, et al. Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study. Resuscitation 2006; 71:283-292. 6 Abella BS, Sandbo N, Vassilatos P, et al. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation 2005; 111:428-434. 7 Zuercher M, Hilwig RW, Ranger-Moore J, et al. Leaning during chest compressions impairs cardiac output and left ventricular myocardial blood flow in piglet cardiac arrest. Crit Care Med 2010; 38:1141-1416. 8** Christenson J, Andrusiek D, Everson-Stewart S, et al. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation 2009; 120:1241-1247. Large observational study of 506 out-of-hospital cardiac arrests. This study showed that chest-compression fraction (proportion of the resuscitation attempt during which chest compressions are being performed) is an independent predictor of survival to hospital discharge in patients who experience a ventricular fibrillation/tachycardia cardiac arrest. Each 10% increase in chest-compression fraction was associated with a 1.11 (95% confidence interval 1.01 to 1.21) increase in the likelihood of survival. 9* Perkins GD, Lockey AS. Defibrillation-safety versus efficacy. Resuscitation 2008; 79:1-3. Editorial review of importance of minimizing preshock pauses and strategies for well tolerated defibrillation. 10 Aufderheide TP, Lurie KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med 2004; 32:S345-S351. 11 Rea TD, Stickney RE, Doherty A, et al. Performance of chest compressions by laypersons during the Public Access Defibrillation Trial. Resuscitation 2010; 81:293-296. 12 Hunt EA, Vera K, Diener-West M, et al. Delays and errors in cardiopulmonary resuscitation and defibrillation by pediatric residents during simulated cardiopulmonary arrests. Resuscitation 2009; 80:819-825. 13 Arshid M, Lo TY, Reynolds F. Quality of cardio-pulmonary resuscitation (CPR) during paediatric resuscitation training: time to stop the blind leading the blind. Resuscitation 2009; 80:558-560. 14 Leary M, Abella BS. The challenge of CPR quality: improvement in the real world. Resuscitation 2008; 77:1-3. 15* Jacobs I. Mechanical chest compression devices: will we ever get the evidence? Resuscitation 2009; 80:1093-1094. Editorial review of recent papers on the use of mechanical chest-compression devices. 16 Deakin CD, Paul V, Fall E, et al. Ambient oxygen concentrations resulting from use of the Lund University Cardiopulmonary Assist System (LUCAS) device during simulated cardiopulmonary resuscitation. Resuscitation 2007; 74:303-309. 17 Steen S, Liao Q, Pierre L, et al. Evaluation of LUCAS, a new device for automatic mechanical compression and active decompression resuscitation. Resuscitation 2002; 55:285-299. 18 Steen S, Sjoberg T, Olsson P, et al. Treatment of out-of-hospital cardiac arrest with LUCAS, a new device for automatic mechanical compression and active decompression resuscitation. Resuscitation 2005; 67:25-30. 19* Bonnemeier H, Olivecrona G, Simonis G, et al. Automated continuous chest compression for in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activity: a report of five cases. Int J Cardiol 2009; 136:e39-50. Case series describing the use of LUCAS-CPR in five patients that sustained in-hospital PEA cardiac arrest. Post mortem study comparing injury patterns between non-survivors of cardiac arrest resuscitated by manual or LUCAS CPR. Injury patterns were similar between groups although the study lacked sufficient power to definitively demonstrate equivalence. 20 Larsen AI, Hjornevik AS, Ellingsen CL, et al. Cardiac arrest with continuous mechanical chest compression during percutaneous coronary intervention A report on the use of the LUCAS device. Resuscitation 2007; 75:454-459. 21 Axelsson C, Nestin J, Svensson L, et al. Clinical consequences of the introduction of mechanical chest compression in the EMS system for treatment of out-of-hospital cardiac arrest: a pilot study. Resuscitation 2006; 71:47-55. 22* Axelsson C, Karlsson T, Axelsson AB, et al. Mechanical active compression-decompression cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end tidal carbon dioxide (P(ET)CO2) during CPR in out-of-hospital cardiac arrest (OHCA). Resuscitation 2009; 80:1099-1103. Observational study of the impact of LUCAS during out-of-hospital cardiac arrest. The study found increased ETCO2 in the LUCAS treated group compared with manual CPR. The study failed to show any difference in survival. 23 Timerman S, Cardoso LF, Ramires JA, et al. Improved hemodynamic performance with a novel chest compression device during treatment of in-hospital cardiac arrest. Resuscitation 2004; 61:273-280. 24 Halperin HR, Paradis N, Ornato JP, 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; 44:2214-2220. 25* Duchateau FX, Gueye P, Curac S, et al. Effect of the AutoPulse automated band chest compression device on hemodynamics in out-of-hospital cardiac arrest resuscitation. Intensive Care Med 2010 [Epub ahead of print] In this before and after the study in 29 patients presenting to the ED with refractory cardiac arrestmedian systolic BP increased from 72[55-105] mmHg with manual CPR to106[78-135] mmHg in the AutoPulse group (P = 0.02). Mean BP increased from 29[25-38] mmHg to 36[30-15] mmHg (P = 0.002). On the contrary, End-Tidal CO(2) did not increase significantly with AutoPulse [21(13-36) vs. 22(12-35) mmHg]. 26 Ong ME, Ornato JP, Edwards DP, et al. Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation. JAMA 2006; 295:2629-2637. 27 Hallstrom A, Rea TD, Sayre MR, et al. Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. JAMA 2006; 295:2620-2628. 28* Paradis NA, Young G, Lemeshow S, et al. In: homogeneity and temporal effects in ASPIRE: an excent from Consent Trial terminated early. Am J Emerg Med 2010. [Epub ahead of print] A post-hoc analysis of the ASPIRE study which found that outcomes at one of the sites differed significantly from the other four sites involved in the trial. This site introduced a protocol change pathway through the trial, which led to a delay in the application of the AutoPulse (applied 112 s after the 1st shock). Survival rates reduced significantly following this change (survival before change 19.6-4%, P = 0.024). Survival at the other sites appeared to be trending in favour of the intervention. 29* Tomte O, Sunde K, Lorem T, et al. Advanced life support performance with manual and mechanical chest compressions in a randomized, multicentre manikin study. Resuscitation 2009; 80:1152-1157. Manikin study showing the variability in effects that introducing mechanical chest-compression device can have in different EMS systems. The study showed that the introduction of a mechanical chest-compression device (AutoPulse) increased no-flow fraction in the best performing EMS but improved it in the worst performing EMS systems. 30 Ong ME, Annathurai A, Leong AS, et al. Cardiopulmonary resuscitation interruptions with use of a load-distributing band device during emergency department cardiac arrest. Ann Emerg Med 2010. http://dx.doi.org/10.1016/j.annemergmed.2010.01.004. 31** Buschmann CT, Tsokos M. Frequent and rare complications of resuscitation attempts. Intensive Care Med 2009; 35:397-404. Review article reporting on the frequency of injuries associated with resuscitation based upon a review of the literature and post-mortem series involving over 1000 patients. The review reports frequent evidence of tracheal injury and rib/sternal fractures. Rarer complications include injury to the pleura, pericardium, myocardium and other internal organs as well as vessels, intubation-related damages of neural and cartilaginous structures in the larynx and perforations of abdominal organs such as liver, stomach and spleen The review identifies that injuries are a common consequence of CPR even when the CPR is performed according to current guidelines. 32 Hoke RS, Chamberlain D. Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation 2004; 63:327-338. 33 Wininger K. Chest compressions: biomechanics and injury. Radiol Technol 2007; 78:269-274. 34* Wind J, Bekkers SC, van Hooren LJ, et al. Extensive injury after use of a mechanical cardiopulmonary resuscitation device. Am J Emerg Med 2009; 27:1017 e1-1017 e2. Case report of a patient that died with massive liver and spleen injury after a combination of manual and mechanical chest compression for aystolic cardiac arrest. 35 Hutchings AC, Darcy KJ, Cumberbatch GL. Tension pneumothorax secondary to automatic mechanical compression decompression device. Emerg Med J 2009; 26:145-146. 36 de Rooij PP, Wiendels DR, Snellen JP. Fatal complication secondary to mechanical chest compression device. Resuscitation 2009; 80:1214-1215. 37 Smekal D, Johansson J, Huzevka T, et al. No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS device: a pilot study. Resuscitation 2009; 80:1104-1107. 38 Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004; 110:588-636. 39 Sunde K, Pytte M, Jacobsen D, et al. Implementation of a standardized treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 2007; 73:29-39. 40 Garot P, Lefevre T, Eltchaninoff H, et al. Six-month outcome of emergency percutaneous coronary intervention in resuscitated patients after cardiac arrest complicating ST-elevation myocardial infarction. Circulation 2007; 115:1354-1362. 41** Sunde K. All you need is flow! Resuscitation 2010. Resuscitation 2010; 81:371-372. Editorial reviewing the role of mechanical chest-compression devices during percutaneous coronary intervention procedures during cardiac arrest. 42 Nielsen N, Sandhall L, Schersten F, et al. Successful resuscitation with mechanical CPR, therapeutic hypothermia and coronary intervention during manual CPR after out-of-hospital cardiac arrest. Resuscitation 2005; 65:111-113. 43 Agostoni P, Cornelis K, Vermeersch P. Successful percutaneous treatment of an intraprocedural left main stent thrombosis with the support of an automatic mechanical chest compression device. Int J Cardiol 2008; 124:e19-e21. 44 Grogaard HK, Wik L, Eriksen M, et al. Continuous mechanical chest compressions during cardiac arrest to facilitate restoration of coronary circulation with percutaneous coronary intervention. J Am Coll Cardiol 2007; 50:1093-1094. 45* Larsen ALH, Bonarjee A, Barvik V, et al. Coronary blood-flow and perfusion pressure during coronary angiography in patients with ongoing mechanical chest compression. Resuscitation 2010; 81:493-497. The case series describing use of LUCAS during cardiac arrest and PCI. Coronary perfusion pressures more than 15 mmHg and TIMI 3 flow were demonstrated in four out of six patients. 46 Nolan JP, Deakin CD, Soar J, et al. European Resuscitation Council Guidelines for Resuscitation 2005 Section 4. Adult advanced life support. Resuscitation 2005; 67(Suppl 1):S39-S86. 47 Narayanan MK, Venkataraju A. Ultrasound in emergency resuscitation. Anaesthesia 2009; 64:787-788. 48 Hernandez C, Shuler K, Hannan H, et al. C.A.U.S. E.: cardiac arrest ultra-sound exam: a better approach to managing patients in primary nonarrhythmogenic cardiac arrest. Resuscitation 2008; 76:198-206. 49* Wirth S, Korner M, Treitl M, et al. Computed tomography during cardiopulmonary resuscitation using automated chest compression devices: an initial study. Eur Radiol 2009; 19:1857-1866. Pilot study examining the potential to undertake CT images during mechanical-chest compression including a case series of three patients during which CT scans were successfully performed. Mechanical CPR needed to be stopped during each set of image acquisition (approximately 20 s) to eliminate movement artefact. Image quality was generally good although the battery unit of AutoPulse had to be removed for brain CT and the LUCAS compression unit needed to be detached from the backplate to fit in the CT scanner. 50* Fieux F, Losser M-R, Bourgeois E, et al. Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors. Critical Care 2009; 13:R141. Case series describing the potential success from organ donation after uncontrolled cardiac arrest. 51 Kootstra G, Daemen JH, Oomen AP. Categories of nonheart-beating donors. Transplant Proc 1995; 27:2893-2894. 52 Morozumi J, Matsuno N, Sakurai E, et al. Application of an automated cardiopulmonary resuscitation device for kidney transplantation from uncontrolled donation after cardiac death donors in the emergency department. Clin Transplant 2009. [Epub ahead of print] 53 Morozumi J, Sakurai E, Matsuno N, et al. Successful kidney transplantation from donation after cardiac death using a load-distributing-band chest compression device during long warm ischemic time. Resuscitation 2009; 80:278-280. 54 Fondevila C, Hessheimer AJ, Ruiz A, et al. Liver transplant using donors after unexpected cardiac death: novel preservation protocol and acceptance criteria. Am J Transplant 2007; 7:1849-1855. 55 Slattery DE, Silver A. The hazards of providing care in emergency vehicles: an opportunity for reform. Prehosp Emerg Care 2009; 13:388-397. 56 Tsou J-Y, Chi C-H, Hsu RM-F, et al. Mechanical loading of the low back during cardiopulmonary resuscitation. Resuscitation 2009; 80:1181-1186. 57 Jones AY. Can cardiopulmonary resuscitation injure the back? Resuscitation 2004; 61:63-67. 58 Olasveengen TM, Wik L, Steen PA. Quality of cardiopulmonary resuscitation before and during transport in out-of-hospital cardiac arrest. Resuscitation 2008; 76:185-190.
URI:	http://wrap.warwick.ac.uk/id/eprint/3327

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