Shoulder strap fixation of LUCAS-2 to facilitate continuous CPR during non-supine (stair) stretcher transport of OHCAs patients

Chen-Bin Chen,Chan-Wei Kuo,Chen-June Seak,Zhong Ning Leonard Goh,Chen-Ken Seak,Joanna Chen-Yeen Seak,Kuan-Fu Chen,Cheng-Yu Chien

doi:10.1038/s41598-021-89291-4

Abstract

Early recognition and rapid initiation of high-quality cardiopulmonary resuscitation (CPR) are key to maximising chances of achieving successful return of spontaneous circulation in patients with out-of-hospital cardiac arrests (OHCAs), as well as improving patient outcomes both inside and outside hospital. Mechanical chest compression devices such as the LUCAS-2 have been developed to assist rescuers in providing consistent, high-quality compressions, even during transportation. However, providing uninterrupted and effective compressions with LUCAS-2 during transportation down stairwells and in tight spaces in a non-supine position is relatively impossible. In this study, we proposed adaptations to the LUCAS-2 to allow its use during transportation down stairwells and examined its effectiveness in providing high-quality CPR to simulated OHCA patients. 20 volunteer emergency medical technicians were randomised into 10 pairs, each undergoing 2 simulation runs per experimental arm (LUCAS-2 versus control) with a loaded Resusci Anne First Aid full body manikin weighing 60 kg. Quality of CPR compressions performed was measured using the CPRmeter placed on the sternum of the manikin. The respective times taken for each phase of the simulation protocol were recorded. Fisher’s exact tests were used to analyse categorical variables and median test to analyse continuous variables. The LUCAS-2 group required a longer time (~ 35 s) to prepare the patient prior to transport (p < 0.0001) and arrive at the ambulance (p < 0.0001) compared to the control group. The CPR quality in terms of depth and rate for the overall resuscitation period did not differ significantly between the LUCAS-2 group and control group, though there was a reduction in both parameters when evaluating the device’s automated compressions during transport. Nevertheless, the application of the LUCAS-2 device yielded a significantly higher chest compression fraction of 0.76 (p < 0.0001). Our novel adaptations to the LUCAS-2 device allow for uninterrupted compressions in patients being transported down stairwells, thus yielding better chest compression fractions for the overall resuscitation period. Whether potentially improved post-OHCA survival rates may be achieved requires confirmation in a real-world scenario study.

Highlights

Survival rates following out-of-hospital cardiac arrests (OHCAs) have improved significantly over the years to the current 8–12%1,2
It represents a huge barrier to the further improvement of cardiopulmonary resuscitation (CPR) quality in countries such as Taiwan where 83.7% of all residency buildings lack elevators[19], and exacerbated by the significant delay faced by emergency medical technicians (EMTs) in accessing patients, especially those located three or more floors above g round[20]
In order to allow the application of LUCAS-2 in these OHCA patients to minimize interruption and maintain high quality CPR during transportation down stairwells, we devised simple adaptations in the form of shoulder straps

Summary

Introduction

Survival rates following out-of-hospital cardiac arrests (OHCAs) have improved significantly over the years to the current 8–12%1,2. There is still room for improvement in patient management at all points in the clinical course of an OHCA, especially early recognition of cardiac arrest and rapid initiation of high-quality cardiopulmonary resuscitation (CPR)[3]. These aspects help maximise chances of achieving successful return of spontaneous circulation (ROSC), as well as improving patient outcomes both inside and outside the hospital[4,5]. Outsourcing of chest compressions to a mechanical device has the added benefit of allowing rescuers to focus on securing the airway via placement of endotracheal tubes or laryngeal mask airways, ensuring proper oxygenation while automated chest compressions are ongoing These devices can only be applied to patients in a supine position. This study aims to examine the effectiveness of our new adaptations to the chest compression device in providing high-quality CPR to simulated OHCA patients

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Conclusion