Mechanical chest compression devices in the helicopter emergency medical service in Switzerland

Urs Pietsch,David Reiser,Jürgen Knapp,Lorenz Meuli,Simon Rauch,Roland Albrecht,Volker Wenzel,Mario Tissi,Lorenz Theiler

doi:10.1186/s13049-020-00758-1

Abstract

BackgroundOver the past years, several emergency medical service providers have introduced mechanical chest compression devices (MCDs) in their protocols for cardiopulmonary resuscitation (CPR). Especially in helicopter emergency medical systems (HEMS), which have limitations regarding loading weight and space and typically operate in rural and remote areas, whether MCDs have benefits for patients is still unknown. The aim of this study was to evaluate the use of MCDs in a large Swiss HEMS system.Materials and methodsWe conducted a retrospective observational study of all HEMS missions of Swiss Air rescue Rega between January 2014 and June 2016 with the use of an MCD (Autopulse®). Details of MCD use and patient outcome are reported from the medical operation journals and the hospitals’ discharge letters.ResultsMCDs were used in 626 HEMS missions, and 590 patients (94%) could be included. 478 (81%) were primary missions and 112 (19%) were interhospital transfers. Forty-nine of the patients in primary missions were loaded under ongoing CPR with MCDs. Of the patients loaded after return of spontaneous circulation (ROSC), 20 (7%) experienced a second CA during the flight. In interhospital transfers, 102 (91%) only needed standby use of the MCD. Five (5%) patients were loaded into the helicopter with ongoing CPR. Five (5%) patients went into CA during flight and the MCD had to be activated. A shockable cardiac arrhythmia was the only factor significantly associated with better survival in resuscitation missions using MCD (OR 0.176, 95% confidence interval 0.084 to 0.372, p < 0.001).ConclusionWe conclude that equipping HEMS with MCDs may be beneficial, with non-trauma patients potentially benefitting more than trauma patients.

Highlights

High-quality chest compressions, minimal hands-off times, and early external defibrillation are crucial for survival with good neurological outcome in patients with cardiac arrest (CA), as underlined by the current resuscitation guidelines [1,2,3]
Of the patients loaded after return of spontaneous circulation (ROSC), 20 (7%) experienced a second CA during the flight
A shockable cardiac arrhythmia was the only factor significantly associated with better survival in resuscitation missions using Mechanical chest compression device (MCD)

Summary

Introduction

High-quality chest compressions, minimal hands-off times, and early external defibrillation are crucial for survival with good neurological outcome in patients with cardiac arrest (CA), as underlined by the current resuscitation guidelines [1,2,3]. The Circulation Improving Resuscitation Care (CIRC), LUCAS in cardiac arrest (LINC) and Prehospital Randomized Assessment of a Mechanical Compression Device (PARAMEDIC) trials have assessed the effect of MCDs on survival In these large prehospital trials, no benefit in patient outcome was shown, the routine use of MCDs is not recommended in ERC and AHA CPR guidelines [10,11,12]. These CPR guidelines, suggest the use of MCDs in situations where providing manual chest compressions is impractical, as a bridge to advanced therapies, or when provider safety is compromised. The aim of this study was to evaluate the use of MCDs in a large Swiss HEMS system

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Conclusion