Figure - available from: Journal of the American College of Emergency Physicians Open
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Overview of cardiopulmonary resuscitation (CPR) timing and clinical outcome, with 1 row for each patient in the final analysis group, showing the durations of manual CPR (yellow) and mechanical CPR (mCPR; black) from the start of CPR until either first return of spontaneous circulation or termination of resuscitation. Patients in the standard manual CPR (sCPR)‐only group received only manual chest compressions; patients in the sCPR + mCPR group transitioned from manual chest compressions to mechanical chest compressions. Vertical (red) dashed lines show median manual CPR time for sCPR‐only and sCPR + mCPR groups. ED, emergency department; ROSC, return of spontaneous circulation.
Source publication
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 c...
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Citations
... In the study by Levy et al patients in both manual and mechanical CPR groups received manual compressions initially. 18 As in our study, the patients treated with mechanical CPR are the patients that are "hard to resuscitate" and consequently, have received a "higher All p-values from independent samples Mann-Whitney U-test except those marked * which are from Chi-square test. For decompression statistics only data from LUCAS 2 AD (intervention group) is available, and statistical testing is not applicable (na). ...
... Of those bleedings evaluated as significant (intrathoracic: pericardia > 0.1 L and/or pleural > 0.2 L, and abdominal > 0.3 L) there were 12 patients (19%) in the LUCAS 2 group and 11 (22%) in the LUCAS 2 AD group. 18 Longer CPR duration may contribute to more injuries as documented by Krischer et al. 10 Ondruschka et al. documented more injuries with longer mechanical chest compression time compared with manual. 19 We also found that CPR duration > 38 minutes (median) increased the risk of significant intrathoracic bleedings (Table 3). ...
Background:
Both skeletal and visceral injuries are reported after cardiopulmonary resuscitation (CPR). This subgroup analysis of a randomized clinical study describes/compares autopsy documented injury patterns caused by two mechanical, piston-based chest compression devices: standard LUCAS® 2 (control) and LUCAS® 2 with active decompression (AD, intervention) in non-survivors with out-of-hospital cardiac arrest (CA).
Method:
We compared injuries documented by autopsies (medical/forensic) after control and intervention CPR based on written relatives consent to use patients' data. The pathologists were blinded for the device used. The cause of CA and injuries reported were based on a prespecified study autopsy template. We used Pearson's chi-squared test and logistic regression analysis with an alpha level of 0.05.
Results:
221 patients were included in the main study (April 2015-April 2017) and 207 did not survive. Of these, 114 (55%, 64 control and 50 intervention) underwent medical (N = 73) or forensic (N = 41) autopsy. The cause of CA was cardiac 53%, respiratory 17%, overdose/intoxication 14%, ruptured aorta 10%, neurological 1%, and other 5%. There were no differences between control and intervention in the incidence of rib fractures (67% vs 72%; p-value = 0.58), or sternal fractures (44% vs 48%; p-value = 0.65), respectively. The most frequent non-skeletal complication was bleeding (26% of all patients) and intrathoracic was the most common location. Ten of the 114 patients had internal organ injuries, where lungs were most affected.
Conclusion:
In non-survivors of OHCA patients, the most frequent cause of cardiac arrest was cardiogenic. Skeletal and non-skeletal fractures/injuries were found in both control and intervention groups. Bleeding was the most common non-skeletal complication. Internal organ injuries were rare.
Background
Tenets of high-quality out-of-hospital cardiac arrest (OHCA) resuscitation include early recognition and treatment of shockable rhythms, and minimizing interruptions in compressions. Little is known about how use of a mechanical compression device affects these elements. We hypothesize that use of such a device is associated with prolonged pauses in compressions to apply the device, and long compression intervals overall.Methods
We systematically abstracted CPR metrics from 4 months of adult non-traumatic OHCA cases, each of which had at least 10 minutes of resuscitation, used a LUCAS device, and had a valid monitor file attached to the patient care report. Our primary outcomes of interest were the duration of each pause in compressions and the duration of compressions between pauses, stratified by whether or not the LUCAS device was used/applied during the segment. Each pause was further evaluated for a possible associated procedure based on pre-defined criteria. Descriptive statistics, chi-square, and Kruskal-Wallis tests were used as appropriate.ResultsFifty-eight cases were included, median age 62.5 years (IQR 49.3-70.8), 47% female, 66% non-White. Overall, 633 compression-pause segments were analyzed (517 with and 116 without LUCAS applied). Spacing of pauses was significantly longer with the LUCAS than without [median (IQR) 133 (82-213) seconds vs. 38 (18-62) seconds, p < 0.05]. When using a LUCAS, compressions were continuous for at least 3 minutes in 166/517 segments, at least 4 minutes in 89/517 segments, and at least 5 minutes in 56/517 segments. Without a LUCAS, compressions were longer than 3 minutes in 7/116 segments. Pauses exceeded 10 seconds more frequently with LUCAS application (32/38) than airway management or defibrillation (27/80, p < 0.05). Peri-LUCAS pauses exceeded 30 seconds in 6/38 cases.ConclusionLUCAS use was associated with long compression intervals without identifiable pauses to assess for pulse or cardiac rhythm, and device application was associated with longer pauses than airway management or defibrillation. The clinical significance and effect on patient outcomes remain uncertain and require further study.
