Automatic and manual mechanical external chest compression devices for cardiopulmonary resuscitation

Abstract

Modern cardiopulmonary resuscitation (CPR) is only 35 years old [1], but Boehm did record successful external CPR in animals in 1878 [2], and Maass described the method in patients in 1892 [3]. Kouwenhoven rediscovered artificial circulation by manual external chest compressions (ECC) in 1960 with laboratory documentation and the first clinical proof of efficacy [1]. Later this group reported that external cardiac massage, combined with artificial respiration could restore cardiac and neurological function before defibrillation in more than 60% of their series of cardiac arrests [4]. Peter Safar organised the knowledge available in the early 1960s into ‘Airway, Breathing and Circulation’ [5]. ECC became step C of the US national [6] and World Federated Society for Anesthesiologists (WFSA) international guidelines [5]. These have been revised several times [7–10], and since 1992 the European Resuscitation Council have published European versions of the guidelines [11,12]. Early defibrillation is the most important single factor to influence survival in out-of-hospital resuscitation, but the majority of patients (\60%) will receive basic life support consisting of chest compression and ventilation before defibrillation is available [12–15]. One study has even suggested that patients suffering cardiac arrest of more than 4 min should be given routinely chest compressions for a short period before defibrillation [16]. Scientists have tried to improve CPR techniques by focusing on manual or automatic driven devices to provide more consistent chest compressions and ventilations. At present there are manual and mechanical automatic devices that provide Vest CPR [17], active compression–decompression (ACD) CPR [18,19], phased thoracic–abdominal compression and decompression (PTACD) CPR [20], standard CPR [21–36], and automatic Belt CPR [unpublished data]. There are four main needs for mechanical ECC: 1. For the scientific study of CPR to provide consistent levels of support according to a protocol. 2. To optimise CPR performance based on the present standards for ECC. 3. To perform CPR using new protocols, optimised for machine resuscitation. 4. To provide basic life support (BLS), and allow the rescuer to concentrate on advanced life support (ALS) and start post resuscitative brain-oriented protective therapy. * +47-22868495. E-mail address: lars.wik@chello.no (L. Wik).