Elsevier

Resuscitation

Volume 179, October 2022, Pages 183-188
Resuscitation

Clinical paper
Mechanical chest compression devices under special circumstances

https://doi.org/10.1016/j.resuscitation.2022.06.014Get rights and content

Abstract

Aim

According to the current resuscitation guidelines, the use of mechanical chest compression devices could be considered under special circumstances like transport with ongoing resuscitation or long-term resuscitation. The aim of this study was to investigate whether survival is improved using mechanical devices under such circumstances.

Methods

Out-of-hospital cardiac arrests from all high-quality data centres of the German Resuscitation Registry from 2007 to 2020 were investigated. The use of mechanical devices was compared separately for transport with ongoing resuscitation, prolonged resuscitation (>45 min), and resuscitation with fibrinolytic agents applied. Baseline characteristics, 30-day survival/discharged alive, and neurological function at discharge were analysed descriptively; and 30-day survival/discharged alive was additionally analysed using multivariate logistic regression.

Results

Overall, patients who were treated with a mechanical device tended to be younger and were significantly more likely to have a witnessed cardiac arrest and a shockable initial rhythm. During the study period, 4,851 patients were transported to hospital with ongoing resuscitation (devices used in 44.2%). The 30-day survival was equal (odds ratio, OR: 1.13, 95%-CI: 0.79–1.60). In 3,920 cases, a resuscitation duration > 45 min was documented (9.5% with device). When a device was used, 30-day survival was significantly increased (OR 2.33, 95%-CI: 1.30–4.15). Fibrinolytic agents were used in 2,106 patients (22.2% with device). Here, 30-day survival was significantly worse with a device (OR: 0.52, 95%-CI: 0.30–0.91).

Conclusion

Mechanical devices are not associated with better survival when used during transport, but rescuer safety could still be an important argument for their use. Devices are associated with better survival in prolonged resuscitation, but worse survival when a fibrinolytic was used.

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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