Clinical paperMechanical chest compression devices under special circumstances
Introduction
In cardiopulmonary resuscitation (CPR), chest compressions are vital until the underlying cause of the cardiac arrest can be found and treated.1 The aim of chest compressions is to maintain some provision of oxygen to the vital organs until the return of spontaneous circulation (ROSC). Therefore, it is necessary that chest compressions be started quickly, performed to a high quality, and interrupted as little as possible.1
However, even professional rescuers do not always succeed in continuously maintaining these recommendations.2., 3. Furthermore, especially during prolonged CPR, there is additional rescuer fatigue and consequent deterioration in the quality of chest compressions.4., 5.
Mechanical chest compression devices, such as Lund University Cardiac Arrest System (LUCASTM, Fa. Jolife AB, Lund, Schweden), AutoPulse® (ZOLL Circulation, Sunnydale, USA), or Corpuls CPR (GS Elektromedizinische Geräte G. Stemple GmbH, Kaufering, Germany), have been developed to perform chest compressions consistently, safely, and in a resource-efficient manner, even over a longer period of time. Large, randomised, multi-centre studies have shown that mechanical devices can safely be used on patients, but their routine use does not correlate with an improvement in survival.6., 7., 8. These results have also been confirmed in a recent meta-analysis.9 Therefore, the current European Resuscitation Council (ERC) guidelines on CPR do not recommend their routine use.10 However, they do mention that these devices may be a useful alternative to manual chest compressions when it is difficult to deliver high-quality manual CPR or when rescuer safety is at risk, such as during transport in an ambulance while CPR is ongoing.10
Various studies have shown that devices can be used safely and consistently during ambulance transport, whereas manual chest compressions are of significantly poorer quality and are associated with a risk to rescuers.11., 12., 13. However, the use of devices during transport to hospital has not yet been shown to be associated with better survival, as it is the same with other possible indications mentioned in the ERC guidelines. Until now, detailed analyses regarding a possible survival benefit are lacking.
Therefore, the aim of this study was to investigate whether the use of mechanical devices is associated with better survival compared to manual chest compression when their use is recommended by the ERC guidelines or should be at least considered. The primary outcome of the study was to evaluate if the use of a mechanical device during transport with ongoing CPR, prolonged CPR or after application of a fibrinolytic agent is associated with a better 30-day survival. The secondary outcomes were to evaluate the occurrence of ROSC and good neurological function at discharge in these situations.
Section snippets
Methods
The study was performed as a retrospective analysis of prospectively collected data from the German Resuscitation Registry. For this purpose, the data were provided completely anonymised by the registry. Drawing conclusions on individual patients or emergency medical services (EMS) was not possible. The study was approved by the Ethics Committee of the University of Ulm (No. 413/21) and the Scientific Board of the German Resuscitation Registry (No. 2021–10). The study was conducted in
Results
In the study period 2007–2020, 43,717 prehospital resuscitations were documented by the data centres. A mechanical device was used in 4,059 cases (9.3%). ROSC rate and 30-day survival/discharged alive were 43.4% and 9.5% when using a device; and 45.0% and 13.5% with manual CPR only (ROSC rate: p = 0.04, 30-day survival: p < 0.001). Younger patients (device vs. manual CPR: 64.5 vs. 69.5 years, p = 0.46), those who had a witnessed cardiac arrest (50.0% vs. 43.0%, p < 0.001), those who received
Discussion
This study is the first to investigate the use of mechanical devices when their use is specifically recommended or should be considered, under current ERC resuscitation guidelines.10 The results show no overall survival benefit during transport with ongoing CPR. Use of a device in long-term CPR is associated with better survival, whereas use after fibrinolytic therapy is associated with significantly worse survival.
The ERC guidelines have not recommended the routine use of mechanical devices in
Conclusion
The use of mechanical devices during transport with ongoing resuscitation is not associated with improved survival. However, the safety of the rescuers could remain a relevant argument for their use. In prolonged resuscitation, the use of mechanical devices is associated with a significant improvement in 30-day survival. This could be a strength of the devices. However, if a fibrinolytic is used during CPR, devices should only be used after a careful risk–benefit assessment.
Declaration of Competing Interest
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Stephan Seewald and Matthias Fischer are members of the organizing committee of the German Resuscitation Registry. The other authors declare they have no conflict of interest.
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