Rescue under ongoing CPR from an upper floor: evaluation of three different evacuation routes and mechanical and manual chest compressions: a manikin trial

Hendrik Drinhaus,Thorsten Annecke,Sebastian Nüsgen,Niels Adams,Wolfgang A Wetsch

doi:10.1186/s13049-020-0709-0

Abstract

BackgroundIf transport under ongoing cardiopulmonary resuscitation (CPR) from an upper floor is indicated, the ideal CPR-method and evacuation route is unknown hitherto. We aimed to elaborate a strategy for evacuation of patients under ongoing CPR from an upper floor, comparing three different evacuation routes and manual and mechanical chest compressions.MethodsA CPR-training manikin recording CPR-quality was placed on the fifth floor and was evacuated to an ambulance via lift, turntable ladder, or staircase. Chest compressions were performed manually or with a mechanical CPR-device. Efficiency endpoints were compression depth and frequency, sufficiency of chest release, compared with European Resuscitation Council (ERC) Guidelines, and duration of the evacuation. Adverse outcomes were disconnection/dislocation of devices and hazards/accidents to the personnel.ResultsFor all evacuation routes, compression depth and frequency were significantly more compliant with ERC-guidelines under mechanical CPR. Manual CPR was associated with considerable deviations from correct compression depth and frequency. Chest release only slightly differed between groups. Evacuation via lift under mechanical CPR was fastest and evacuation via turntable ladder under manual CPR was slowest. No device disconnections or accidents occurred, but hazard to personnel was perceived during evacuation via ladder under manual CPR.ConclusionsIn this study, a mechanical CPR-device proved to deliver better CPR-quality during evacuation from an upper floor. If a lift accessible with a stretcher is available, this route should be preferred, regardless of manual or mechanical CPR. Turntable ladders can only be meaningfully used with mechanical CPR, otherwise CPR-quality is poor and hazard to the personnel is increased. Not all evacuation routes may be useable in a specific real-life scenario.Trial registrationGerman Clinical Trials Registry, www.drks.de, registration number DRKS00012885, registration date 17.08.2017.

Highlights

If transport under ongoing cardiopulmonary resuscitation (CPR) from an upper floor is indicated, the ideal CPR-method and evacuation route is unknown hitherto
Some emergency medical services (EMS)-systems prefer establishing extracorporeal cardiopulmonary resuscitation by implanting a veno-arterial extracorporeal membrane oxygenation (ECMO) on scene [3], whereas other concepts recommend transporting the patient to the hospital under ongoing CPR and establishing ECMO in-hospital [1]
Compression depth The compression depth recommended by the guidelines of the European Resuscitation Council (ERC) is 50 to 60 mm

Summary

Introduction

If transport under ongoing cardiopulmonary resuscitation (CPR) from an upper floor is indicated, the ideal CPR-method and evacuation route is unknown hitherto. We aimed to elaborate a strategy for evacuation of patients under ongoing CPR from an upper floor, comparing three different evacuation routes and manual and mechanical chest compressions. In order to deliver high-quality chest compressions and to reduce risks of injury to the personnel during patient transport, mechanical CPR devices can potentially be helpful, even though their use has not proven to be superior to manual CPR and is not recommended for standard CPR in a static situation [4,5,6,7,8]. We sought to establish the optimal strategy for evacuation of a simulated patient under ongoing CPR from the fifth floor To this end, evacuation via lift, turntable ladder, or staircase was tested, using either manual or mechanical CPR

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