Manual Cardiopulmonary Resuscitation Research Articles

Mechanical Cardiopulmonary Resuscitation (CPR) Is Better Than Manual CPR? Literature Study

Introduction: Mechanical CPR mitigate rescuer fatigue and ensure adherence to guidelines, potentially enhancing overall survival rates. Contrarily, manual CPR relies on human skill, presenting challenges in maintaining uniformity and endurance. Unveiling the complexities within this juxtaposition becomes imperative in shaping future resuscitative paradigms. The purposeof studi is to determine the effectiveness of mechanical CPR in cardiac arrest management compared to manual CPRMethods: Database used were Pubmed and Proquest using the keywords "Mechanical CPR", "Automatic CPR Device" and "Cardiac Arrest". The inclusion criteria were last 5 years published, analyzing the effect of automatic CPR devices on cardiac arrest management, as well as full text articles. The inclusion criteria are literature review, systematic review or is not original research. The number of articles eligible for review is 10 journal articlesResults: The use of automatic CPR equipment is still inferior compared to manual CPR during cardiac arrest with the use value being 4-5% of all cardiac arrest patients. There are 4 journals that state that ROSC in cardiac arrest management using automatic CPR devices is higher than manual, but there are 2 journal articles that report the opposite. Automatic CPR device is very vulnerable to injury with fractures reaching 85.5% of total injuries compared to manual CPR which does not experience injury.Conclusion: The use of automatic CPR device does not produce better results than manual CPR overall for ROSC, but is very useful and meaningful in certain conditions such as during the transportation process, therefore, the automatic CPR device is more meaningful for pre-hospital useKeywords: Manual CPR; Mechanical CPR; CPR; OHCA

Rib fractures and other injuries after cardiopulmonary resuscitation for non-traumatic cardiac arrest: a systematic review and meta-analysis.

This study aims to ascertain the prevalence of rib fractures and other injuries resulting from CPR and to compare manual with mechanically assisted CPR. An additional aim was to summarize the literature on surgical treatment for rib fractures following CPR. Systematic review and meta-analysis. Embase, Medline Ovid, Cochrane Central, Web of Science, and Google Scholar. The databases were searched to identify studies reporting on CPR-related injuries in patients who underwent chest compressions for a non-traumatic cardiopulmonary arrest. Subgroup analysis was conducted to compare the prevalence of CPR-related injuries in manual versus mechanically assisted chest compressions. Studies reporting on surgery for CPR-related rib fractures were also reviewed and summarized. Seventy-four studies reporting CPR-related injuries were included encompassing a total of 16,629 patients. Any CPR-related injury was documented in 60% (95% confidence interval [95% CI] 49-71) patients. Rib fractures emerged as the most common injury, with a pooled prevalence of 55% (95% CI 48-62). Mechanically assisted CPR, when compared to manual CPR, was associated with a higher risk ratio for CPR-related injuries of 1.36 (95% CI 1.17-1.59). Eight studies provided information on surgical stabilization of CPR-related rib fractures. The primary indication for surgery was the inability to wean from mechanical ventilation in the presence of multiple rib fractures. Rib fractures and other injuries frequently occur in patients who undergo CPR after a non-traumatic cardiopulmonary arrest, especially when mechanical CPR is administered. Surgical stabilization of CPR-related rib fractures remains relatively uncommon. Level III, systematic review and meta-analysis.

Injuries Associated with Prehospital CPR Provided by Professionals and Non-Professionals in Bangkok EMS

Background: This study is to concentrate on adverse outcomes of CPR in out-of-hospital cardiac arrest (OHCA) among different performers that are trained first responders, professional practitioners, and automated devices by exploring types of injuries and comparing between datasets. It is also to find out potential contributing factors for each injury which display statistical significance.
 Methods: Forensic autopsy data from a single center covering almost half of Bangkok and her outskirts which were performed during October 2020 to January 2021 were retrospectively collected and analyzed. The data were divided into 3 groups, namely, TFR (trained first responder), PP (professional practitioner), and Auto (automated device i.e. LUCAS system). Thoraco-abdominal injuries were recorded including soft tissue, bone and internal viscera. Factors including age, BMI, sternal length (SL) and chest circumference (CC) were categorized in each injury. Statistical comparison between groups and analysis for significant factors were performed.
 Results: A total number of 158 cases reported as OHCA with exclusion of thoraco-abdominal injuries were recruited. The most commonly found as a hallmark of CPR injuries are chest wall fractures especially those of ribs (65.7%). Bilateral anterior rib fractures are more common than unilateral. Significantly associated factors to rib fractures are age and BMI. Other injuries are sternal fractures, lung contusions and lacerations, epicardial and subendocardial hemorrhages, cardiac contusions, liver lacerations, and pancreatic and splenic hemorrhages. No statistical difference between injuries generated by trained first responders and professional practitioners. LUCAS devices show higher incidence of injuries than manual CPR.
 Conclusion: This study may provide useful information for clinicians to investigate and monitor potential CPR complications as well as for forensic physicians to concern the injuries possibly caused by CPR.

A Case of Coronary Artery Perforation Caused by Manual Cardiopulmonary Resuscitation in the Catheterization Laboratory

A Case of Coronary Artery Perforation Caused by Manual Cardiopulmonary Resuscitation in the Catheterization Laboratory

Real-world comparison between mechanical and manual cardiopulmonary resuscitation during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, including an increase in out-of-hospital cardiac arrests (OHCA). Healthcare providers are now required to use personal protective equipment (PPE) during cardiopulmonary resuscitation (CPR). Additionally, mechanical CPR devices have been introduced to reduce the number of personnel required for resuscitation. This study aimed to compare the outcomes of CPR performed with a mechanical device and the outcomes of manual CPR performed by personnel wearing PPE. MethodsThis multicenter observational study utilized data from the Korean Cardiac Arrest Research Consortium registry. The study population consisted of OHCA patients who underwent CPR in emergency departments (EDs) between March 2020 and June 2021. Patients were divided into two equal propensity score matched groups: mechanical CPR group (n = 421) and PPE-equipped manual CPR group (n = 421). Primary outcomes included survival rates and favorable neurological outcomes at discharge. Total CPR duration in the ED was also assessed. ResultsThere were no significant between-group differences with respect to survival rate at discharge (mechanical CPR: 7.4% vs PPE-equipped manual CPR: 8.3%) or favorable neurological outcomes (3.3% vs. 3.8%, respectively). However, the mechanical CPR group had a longer duration of CPR in the ED compared to the manual CPR group. ConclusionThis study found no significant differences in survival rates and neurological outcomes between mechanical CPR and PPE-equipped manual CPR in the ED setting. However, a longer total CPR duration was observed in the mechanical CPR group. Further research is required to explore the impact of PPE on healthcare providers' performance and fatigue during CPR in the context of the pandemic and beyond.

Prophylactic supplement with melatonin prevented the brain injury after cardiac arrest in rats

Prophylactic pharmacotherapy for health care in patients with high risk of cardiac arrest (CA) is an elusive and less explored strategy. Melatonin has possibilities used as a daily nutraceutical to trigger the cellular adaptation. We sought to find the effects of long-term daily prophylactic supplement with melatonin on the victim of CA. Rats were divided into sham, CA, and melatonin + CA (Mel + CA) groups. The rats in the Mel + CA group received daily IP injection of melatonin 100 mg/kg for 14 days. CA was induced by 8 min asphyxia and followed by manual cardiopulmonary resuscitation. The endpoint was 24 h after resuscitation. Survival, neurological outcome, and hippocampal mitochondrial integrity, dynamics and function were assessed. Survival was significantly higher in the Mel + CA group than the CA group (81 vs. 42%, P = 0.04). Compared to the CA group, neurological damage in the CA1 region and the level of cytochrome c, cleaved caspase-3 and caspase-9 in the Mel + CA group were decreased (P < 0.05). Mitochondrial function and integrity were protected in the Mel + CA group compared to the CA group, according to the results of mitochondrial swelling, ΔΨm, ROS production, oxygen consumption rate, and respiratory control rate (P < 0.05). Melatonin increased SIRT3 and downregulated acetylated CypD. The mitochondrial dynamics and autophagy were improved in the Mel + CA group (P < 0.05). Long-term daily prophylactic supplement with melatonin buy the time from brain injury after CA.

Does the type of mechanical chest compressor affect resuscitation outcome of out of hospital cardiac arrest patients? A propensity-score based comparison of three devices

Abstract Background Mechanical cardiopulmonary resuscitation (CPR) devices are currently recommended when high-quality CPR could not be provided and only if used by trained rescuers. Guidelines are against their routinely use since clinical trials results are controversial, and solid evidence of improved survival are missing. Moreover, many studies compared these devices to very high-quality manual CPR, hardly replicable in a pre-hospital emergency setting. Nowadays, different machines are available but literature is poor in direct comparison studies. Purpose To assess whether the type of mechanical chest compressor could affect the probability of return of spontaneous circulation (ROSC) and of 30-days mortality after an out-of-hospital cardiac arrest (OHCA) as compared to manual standard CPR. Methods Data were prospectively collected from our Utstein-based cardiac arrest registry. We considered all OHCAs from January 1, 2015 to December 31, 2022 from 7 provinces covered by the same regional emergency system (population covered 4.2mln. inhabitants) but equipped with three different types of mechanical compressor: Autopulse®; LUCAS® and Easy Pulse®. Patients treated with mechanical CPR and manual CPR were randomly matched via a multivariable logistic regression propensity score considering age, gender, witnessed OHCA, presence of bystander CPR, first rhythm recorded, EMS arrival time and lay defibrillation before EMS arrival. Logistic regression and COX regression models were performed and adjusted for resuscitation duration to investigate the association between the type of CPR and the probability of ROSC and of 30-day mortality. Results Among 13,203 OHCAs with attempted CPR, 10,497 (79.5%) received manual CPR and in 2,405 (18.2%) mechanical CPR [Easy Pulse® in 1,102(45.8%), Autopulse® in 776 (32.3%) and LUCAS® in 521 (21.7%)]. ROSC before hospital admission was obtained in 1,712 patients (13.0%) and 762 (5.8%) were alive after 30 days. After propensity score matching two homogeneous groups of 1,946 patients each (manual and mechanical CRP) were identified. The rate of ROSC and of 30-day survival were lower in the mechanical CPR group (ROSC: 14.7% vs 24.1%; p&amp;lt;0.001; 30-day survival 6% vs 14%; p&amp;lt;0.001). The three devices showed an independent association with the probability of ROSC as compared to manual CPR [Autopulse®: OR 1.76, 95% CI (1.36-2.28) p&amp;lt;0.001; LUCAS®:OR 1.55, 95% CI (1.13-2.13), p=0.006 and Easy Pulse®:OR 0.49; 95% CI (0.37-0.65), p&amp;lt;0.001] (Figure 1A). Only Autopulse® was independently associated with 30-day mortality [AutoPulse HR 0.87, 95%CI (0.79-0.97), p=0.01; LUCAS®: HR 1.00, 95%CI (0.88-1.14), p=0.97) and Easy Pulse®: HR: 1.06, 95%CI (0.97-1.16), p=0.19] (Figure 1B). Conclusions This is the first study comparing the performance of three devices for mechanical chest compressions revealing that they differently affect the probability of ROSC and of 30-day survival.

Abstract 278: Injuries and Outcomes Associated With Manual vs Mechanical CPR Post Out of Hospital Cardiac Arrest

Objectives: Mechanical CPR is increasingly being used for field out of hospital cardiac arrest (OHCA) care. However, existing literature does not identify a survival benefit of mechanical versus manual CPR. We hypothesized that CPR related injury may impact patient outcomes. For that reason, our primary objective is to compare mechanical and manual CPR-related injury in resuscitated OHCA patients. Our secondary objective is to compare hospital outcomes including length of stay (LOS) and survival between these two CPR methods. Methods: We performed a retrospective study of adult OHCA patients admitted to three teaching hospitals in Southeastern Michigan from 2017-2021. Resuscitated patients were matched to hospital electronic medical records (EMRs), included if they had CT imaging of chest or abdomen/pelvis, and then dichotomized by CPR method. Patients were excluded if no EMR match or CPR method was unknown. Hospital EMRs were queried for CT imaging results, LOS variables and survival to hospital discharge. Injuries are identified using hospital ICD-10 codes. Univariate statistics are reported. Results: There were 808 patients admitted after OHCA, with 235 (103 mechanical CPR, 132 manual CPR) meeting the inclusion criteria. Demographics between groups were similar in age, gender, or body mass index (BMI). There were no abdominal/visceral injuries and few patients (4) had a pneumothorax. CPR associated injury was more common with manual CPR (28.8% vs 15.5%, p=0.02) and an increased rate of rib(s), sternum, or thoracic spine fracture (27.3% vs 14.6%, p=0.02). . We identified no differences in survival to hospital discharge (39 (29.5%) vs. 29 (28.2%), p=0.8), median hospital LOS, ICU LOS, and ventilator time between groups. Paradoxically amongst survivors, mechanical CPR was associated with longer LOS (15.7 vs 11.0 days, p=0.012) and a non-significant increased ventilator time (143 vs 99 hours, p=0.23). Conclusion: We identified a higher rate of injury with manual CPR compared to mechanical CPR in resuscitated OHCA patients We also did not identify any association between CPR method and ICU LOS, ventilator time, and survival. Further work is needed to assess the impact on outcome of CPR method and injuries typically associated with resuscitation.

Abstract 222: Real Time Feedback of Chest Compressions by Hands-Free Carotid Doppler in a Porcine Model

Background: Real-time hemodynamic feedback devices provide information on cardiopulmonary resuscitation (CPR) quality. This can improve hand positioning and technique, thereby maximizing blood flow and potentially improve survival. Hypothesis: We hypothesize that a newly developed hands-free Doppler for carotid blood flow velocity (RescueDoppler, RD), can identify optimal vs. suboptimal chest compression sites during CPR. Aim: To assess the potential of the RD device to continuously monitor the effect of each compression by ultrasound metrics and waveforms in a porcine model. Methods: Ventricular fibrillation was induced in 5 pigs using an ICD. Manual CPR (blinded for hemodynamic data) was performed for 10 seconds at 3 different compression sites in random order (Fig.), and repeated 6 times. We analyzed ultrasound waveforms with Time Average Velocity (TAV) in a linear mixed model with site as fixed effect, and animal and site within animal as random effects. We further compared TAV to invasive systolic blood pressure (SBP) from the contralateral carotid artery. Results: Data from 5 pigs (mean weight 31.2 kg) and 29 of 30 sequences were included. Overall, blood flow velocity was highest at compression site 2 (TAV 33 cm/s, P&lt;0.01), but there was significant variability (P&lt;0.01) in animals (SD= 3.7) and at sites within animal (SD= 7). A compression site yielding the highest TAV (range 19 to 48 cm/s) or lowest TAV (6-25 cm/s) was successfully identified in all animals with corresponding SBPs 50-81 mmHg, and 46-64 mmHg, respectively. The correlation between TAV and SBP was 0.62-0.90 within animals. Conclusions In this animal study, a newly developed hands-free Doppler enabled assessment of blood flow velocity during CPR and detected significant variation according to chest compression site. RD identified the sites with both high and low blood flow velocities and is thus a promising device for effectively identifying the optimal and suboptimal chest compression sites during CPR.

Abstract 17808: Neuroprotective Effects of 4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid Inhibition on Voltage-Dependent Anion Channel 1 or Ruthenium Red Inhibition on Mitochondrial Calcium Uniporter After Cardiac Arrest

Introduction: Mitochondrial dysfunction is associated with poor neurological outcomes after resuscitation. Over the past decade, identification of the mitochondrial outer membrane voltage-dependent anion channel 1 (VDAC1) and inner membrane mitochondrial calcium uniporter (MCU) has provided insight into the roles that mitochondrial Ca2+ regulation plays in neuronal function after cardiac arrest (CA). Hypothesis: The neuroprotective effects of 4,4'-Diisothiocyanostilbene-2,2'-disulfonic Acid (DIDS) inhibition on VDAC1 or Ruthenium red (RUR) inhibition on MCU after asphyxial CA in rats were investigated. Methods: Male SD rats, 240-340 g, were subjected to 8 min asphyxial CA and followed by manual cardiopulmonary resuscitation. Sham, Control, DIDS, RUR, DIDS+RUR groups were included. The rats in the DIDS, RUR, DIDS+RUR groups received 7 mg/kg DIDS, 3 mg/kg RUR or 7 mg/kg DIDS combined with 3 mg/kg RUR immediately after return of spontaneous circulation (ROSC). Survival and Neurologic Deficit Score were assessed at 24 h after ROSC. Neurological outcome was assessed. Hippocampal mitochondrial apoptosis was measured. Results: Survival was significantly higher in the RUR group compared to the Control group (85% vs. 40%, P &lt; 0.05). NDS in the DIDS and RUR groups were significantly better than in the Control group (P &lt; 0.05). Neurons were less damaged in the DIDS, RUR, DIDS+RUR groups than in the Control group (Figure). Cyt.C was lower in the DIDS, RUR, DIDS+RUR groups than in the Control group (P &lt; 0.05). Bax was lower in the RUR, DIDS+RUR groups than in the Control group (P &lt; 0.05). Bcl-2 was highly expressed in the RUR group than in the Control group (P &lt; 0.05). Cleaved caspase-3 was lower in the DIDS+RUR group (P &lt; 0.05). AIF was higher in the DIDS and RUR groups compared to the Control group (P &lt; 0.05). Conclusions: Inhibiting VDAC1 or MCU significantly improved survival, neurological outcome and inhibited hippocampal mitochondrial apoptosis after CA.

Abstract 276: Characterization of Chest Dynamics During Out-of-Hospital Manual Cardiopulmonary Resuscitation

Introduction: Viscoelastic models are widely accepted in modern literature to explain the non-linear relationship between the force applied by the rescuer and the chest displacement that occurs during chest compressions (CCs). Various studies have shown that applying CCs for prolonged periods of time changes chest properties, but proposed models have mostly been tested under laboratory settings with few patients or during short CPR intervals. Aim: To retrospectively characterize the mechanical dynamics of the chest during manual CCs in pre-hospital cardiopulmonary resuscitation using a simple viscoelastic model. Methods: Force and acceleration signals were extracted from CPR monitors used during pre-hospital resuscitation efforts by TVF&amp;R (OR, USA) on adult patients (≥ 18yo), from which individual CCs and series of CCs between pauses were identified. The model decomposes the measured force as the sum of an elastic term and a damped term, specifically F = k·x + d·v . We characterized each full cycle with a spring coefficient k (N/cm) to measure the stiffness of the chest; and with separated compression and recoil damping coefficients, d c and d r (N·s/cm), to measure its viscosity. Parameters were averaged for sets of 10 CCs. We characterized the variations of the model parameters within each series. We also assessed the chest recovery between consecutive series by comparing the values obtained at the end of each series with the beginning of the next series. Results: A total of 1,156,608 CCs from 615 patients were analysed. From these, 6,073 series of median (IQR) length 190 (119-222) CCs were selected. All parameters decreased within the series, with decreases of the median after 20 sets of 10 CCs of 9.8%, 7.1% and 11.1% for k , d c and d r , respectively (p trend &lt; 0.05). When examining the first 5 series for all cases, k presented a mean recovery of 7%, d c of 5%, and d r of 5%. Conclusion: The proposed model allows the observation of a reduction in stiffness and viscosity of the chest within CC series. It further allows for evaluating the dynamics of the chest around pauses, showing recovery of its properties during the pause. Overall, the model reveals a gradual reduction in chest stiffness and viscosity during CPR.

Abstract 108: Mitochondria-Targeted S-Nitrosothiol MitoSNO Improves Neurological Recovery and Survival After Asphyxial Cardiac Arrest in Rats

Introduction: Mitochondria-targeted S-nitrosothiol MitoSNO offers protection against ischemia-reperfusion injury by attenuating the reverse electron transport of mitochondrial complex I during reperfusion. This study aimed to assess whether administration of MitoSNO after ROSC improves neurological and survival outcomes following cardiac arrest (CA). Methods: Adult male rats were subjected to 10 minute of asphyxial CA followed by mechanical ventilation and manual CPR. After successful CPR, animals were assigned to one of two experimental groups: receiving respiration buffer as a vehicle or MitoSNO (100 ng per dose). Based on our preliminary study, two doses of each drug were intravenously injected via femoral vein: immediately after ROSC and at 60 minutes post-ROSC. The survival time and neurological function score (NFS) were recorded for up to 72 h. Surgery, CPR, drug injections, echocardiography, and immunohistochemistry were performed in a blind manner. Results: MitoSNO significantly improved NFS and survival rate ( Fig A ). Echocardiography revealed that MitoSNO improved left ventricular ejection fraction 2 h post-ROSC compared to the vehicle. In another set of experiments, relative cerebral blood flow (rCBF) compared to baseline was invasively monitored at 2 h post-CA using a laser speckle imaging. The imaging showed CA caused a reduction in rCBF 2 h post-CA in the vehicle group, which was markedly improved by MitoSNO ( Fig B ). Western blotting assay showed, in brain 2 h post-CA, MitoSNO significantly mitigated protein levels of 3-NT, a marker for nitrogen free radical-modified proteins, and cleaved Caspase-3, an indicator of programmed cell death. Immunohistochemistry revealed that MitoSNO suppressed neuronal degeneration in vulnerable brain regions of surviving animals. Conclusions: Our study demonstrated that MitoSNO inhibited the production of oxidative stress in the brain and improved neurological and survival outcomes following CA in rats.

Abstract 13334: Safety of Chest Compressions in Patients With a Durable Left Ventricular Assist Device

Introduction: The safety of chest compressions (CC) during cardiopulmonary resuscitation (CPR) among pts with a durable left ventricular assist device (LVAD) is an area of controversy. Concerns regarding device malfunction or dislodgment with CC may result in significant delays or the withholding of life-sustaining intervention entirely. Current societal guidelines, based on small case reports, suggest that manual CC are probably not harmful, but offer no additional guidance. Furthermore, they acknowledge that there are no data regarding the use of machine-assisted CC. Methods: We retrospectively reviewed medical records of consecutive pts who underwent durable LVAD implantation at Duke University from 2013-2022. Charts were searched for “code”, “arrest”, “compressions”, and “rapid response team” to identify all instances of cardiac arrest (CA). Baseline pt characteristics, details of the arrest (including CC details), in-hospital care processes, and pt outcomes were abstracted. Results: Of 750 pts reviewed, 58 (mean age 64 years, 76% male, median LVAD support duration 19 months) had documented CA. Fifteen (26%) pts presented with an out-of-hospital CA. Twenty-four (41%) pts did not receive CC. The most commonly reported reason for avoiding CC was “LVAD in place - contraindicated.” The CPR duration was longer among those who received CC (median 30mins, range: 1-120 mins) than those who did not (median 20 mins, range: 2-79 mins). Two pts had support from a Lund University Cardiac Assist System (LUCAS) device. Among those who survived either manual and machine-assisted CC, 27% had a post-arrest TTE and none showed evidence of LVAD malfunction/dislodgment. Conclusions: Among pts with a durable LVAD who underwent CPR for CA we found no evidence of device dislodgment or safety concerns associated with either manual or LUCAS-assisted CPR. Future multicenter and prospective evaluation is necessary to both confirm these findings and to inform the guidelines.

359 Manual Versus Mechanical Cardiopulmonary Resuscitation Complications After Successful Resuscitation for Out-of-Hospital Cardiac Arrest

359 Manual Versus Mechanical Cardiopulmonary Resuscitation Complications After Successful Resuscitation for Out-of-Hospital Cardiac Arrest

An evaluation of the NUI Compact Chest Compression Device (NCCD), a mechanical CPR device suitable for use in the saturation diving environment.

Provision of manual chest compressions in a diving bell using a conventional technique is often impossible, and alternative techniques are poorly evidenced in terms of efficacy and sustainability. The first mechanical cardiopulmonary resuscitation (CPR) device suitable for use in this environment, the NUI Compact Chest Compression Device (NCCD), has recently been designed and manufactured. This study assessed both the efficacy of the device in delivering chest compressions to both prone and seated manikins, and the ability of novice users to apply and operate it. Compression efficacy was assessed using a Resusi Anne QCPR intelligent manikin, and the primary outcome was the proportion of compressions delivered to target depth (50-60 mm). The gold standard was that achieved by expert CPR providers delivering manual CPR; the LUCAS 3 mCPR device was a further comparator. The NCCD delivered 100% of compressions to target depth compared to 98% for the gold standard (interquartile range 1.5%) and 98% for the LUCAS 3 when applied to both supine and seated manikins. The NCCD sometimes became dislodged and had to be reapplied when used with a seated manikin. The NCCD can deliver chest compressions at target rate and depth to both supine and seated manikins with efficacy equivalent to manual CPR and the LUCAS 3. It can become dislodged when applied to a seated manikin; its design has now been altered to prevent this. New users can be trained in use of the NCCD quickly, but practise is required to ensure effective use.

Delivering manual cardiopulmonary resuscitation (CPR) in a diving bell: an analysis of head-to-chest and knee-to-chest compression techniques.

Chest compression often cannot be administered using conventional techniques in a diving bell. Multiple alternative techniques are taught, including head-to-chest and both prone and seated knee-to-chest compressions, but there are no supporting efficacy data. This study evaluated the efficacy, safety and sustainability of these techniques. Chest compressions were delivered by a team of expert cardiopulmonary resuscitation (CPR) providers. The primary outcome was proportion of chest compressions delivered to target depth compared to conventional CPR. Techniques found to be safe and potentially effective by the study team were further trialled by 20 emergency department staff members. Expert providers delivered a median of 98% (interquartile range [IQR] 1.5%) of chest compressions to the target depth using conventional CPR. Only 32% (IQR 60.8%) of head-to-chest compressions were delivered to depth; evaluation of the technique was abandoned due to adverse effects. No study team member could register sustained compression outputs using prone knee-to-chest compressions. Seated knee-to-chest were delivered to depth 12% (IQR 49%) of the time; some compression providers delivered > 90% of compressions to depth. Head-to-chest compressions have limited efficacy and cause harm to providers; they should not be taught or used. Prone knee-to-chest compressions are ineffective. Seated knee-to-chest compressions have poor overall efficacy but some providers deliver them well. Further research is required to establish whether this technique is feasible, effective and sustainable in a diving bell setting, and whether it can be taught and improved with practise.

Manual vs Mechanical Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest on a Ski Slope: A Pilot Study.

The quality of cardiopulmonary resuscitation (CPR) is critical in increasing the probability of survival with a good neurologic outcome after out-of-hospital cardiac arrest. In an austere environment with a potentially salvageable patient, bystanders or first responders may need to provide chest compressions for a prolonged duration or during physically challenging transportation scenarios. Consequently, they may be at risk of fatigue or injury, and chest compression quality may deteriorate. The study sought to assess whether or not access to and utilization of a mechanical compression device (Lund University Cardiopulmonary Assist System) was feasible and not inferior to manual compressions while extricating and transporting a patient from a ski slope. Variable 3-person ski patrol teams responded to a simulated patient with out-of-hospital cardiac arrest in a nonshockable rhythm. Using a mannequin and CPR quality monitor, performance during manual CPR was compared with that of a mechanical compression device. This is a prospective, crossover analysis of CPR quality during extrication from a ski slope. Across 8 total runs, chest compression fraction, which is the proportion of time without spontaneous circulation during which compressions occurred, and high-quality CPR, as measured by appropriate rate and depth, were compared between the 2 groups. Extrication times between the 2 groups were also measured. There was no difference in compression fraction between the manual (91.4%; 95% CI [86.8-96.1]) and mechanical arms (92.8%; 95% CI [88.8-96.8]) (P=0.67). There was an increase in the time performing high-quality CPR in the mechanical group (58.5%; 95% CI [45.8-71.2]) vs that in the manual group (25.6%; 95% CI [13.5-37.8]) (P<0.001). There was a statistically significant difference in the extrication times between the 2 groups, 7.6 ± 0.5 min in the manual group vs 8.6 ± 0.4 min in the mechanical group (P=0.014). Mechanical CPR devices are noninferior for use in ski areas during initial resuscitation and transportation. Compared with manual CPR, mechanical CPR would likely improve the fraction of time performing high-quality CPR.

Use of Mechanical Chest Compression for Resuscitation in Out-Of-Hospital Cardiac Arrest-Device Matters: A Propensity-Score-Based Match Analysis.

Devices for mechanical cardiopulmonary resuscitation (CPR) are recommended when high quality CPR cannot be provided. Different devices are available, but the literature is poor in direct comparison studies. Our aim was to assess whether the type of mechanical chest compressor could affect the probability of return of spontaneous circulation (ROSC) and 30-day survival in Out-of-Hospital Cardiac Arrest (OHCA) patients as compared to manual standard CPR. We considered all OHCAs that occurred from 1 January 2015 to 31 December 2022 in seven provinces of the Lombardy region equipped with three different types of mechanical compressor: Autopulse®(ZOLL Medical, MA), LUCAS® (Stryker, MI), and Easy Pulse® (Schiller, Switzerland). Two groups, 2146 patients each (manual and mechanical CPR), were identified by propensity-score-based random matching. The rates of ROSC (15% vs. 23%, p < 0.001) and 30-day survival (6% vs. 14%, p < 0.001) were lower in the mechanical CPR group. After correction for confounders, Autopulse® [OR 2.1, 95%CI (1.6-2.8), p < 0.001] and LUCAS® [OR 2.5, 95%CI (1.7-3.6), p < 0.001] significantly increased the probability of ROSC, and Autopulse® significantly increased the probability of 30-day survival compared to manual CPR [HR 0.9, 95%CI (0.8-0.9), p = 0.005]. Mechanical chest compressors could increase the rate of ROSC, especially in case of prolonged resuscitation. The devices were dissimilar, and their different performances could significantly influence patient outcomes. The load-distributing-band device was the only mechanical chest able to favorably affect 30-day survival.

AUTOMATIC BELT CARDIOPULMONARY RECISUTATION (CPR) DEVICE AND TEST SYSTEM DESIGN

The test system was created by adding flex and force sensors to this manikin to evaluate the results of heart massage applied on an artificial adult manikin, which has a spring that can give the chest stiffness of an adult human. This test system monitors and analyzes cardiopulmonary resuscitation (CPR) applications performed by the automated CPR device or manually by the person. The signals received from the sensor are transferred to the computer via the serial port with the Arduino Uno card and displayed in real-time in MATLAB graphical user interface (GUI). This GUI, designed with Matlab 2021a software, analyzes the sensor signals resulting from CPR. It gives a graph of the repeats of compression per minute, the depth of each compression, and the compressions rate variable performed by the user or the automatic CPR device during the CPR application. This created test system can evaluate the accuracy of both the automatic CPR device performed in this study and the manual CPR application. The test system designed in this respect can be used in the training and evaluation of cardiac massage applications, which is included in the first aid courses in secondary education, associate degree, undergraduate, and vocational education courses.

Impedance-based Ventilation Detection and Signal Quality Control during Out-of-Hospital Cardiopulmonary Resuscitation.

Feedback on ventilation could help improve cardiopulmonary resuscitation quality and survival from out-of-hospital cardiac arrest (OHCA). However, current technology that monitors ventilation during OHCA is very limited. Thoracic impedance (TI) is sensitive to air volume changes in the lungs, allowing ventilations to be identified, but is affected by artifacts due to chest compressions and electrode motion. This study introduces a novel algorithm to identify ventilations in TI during continuous chest compressions in OHCA. Data from 367 OHCA patients were included, and 2551 one-minute TI segments were extracted. Concurrent capnography data were used to annotate 20724 ground truth ventilations for training and evaluation. A three-step procedure was applied to each TI segment: First, bidirectional static and adaptive filters were applied to remove compression artifacts. Then, fluctuations potentially due to ventilations were located and characterized. Finally, a recurrent neural network was used to discriminate ventilations from other spurious fluctuations. A quality control stage was also developed to anticipate segments where ventilation detection could be compromised. The algorithm was trained and tested using 5-fold cross-validation, and outperformed previous solutions in the literature on the study dataset. The median (interquartile range, IQR) persegment and per-patient F1-scores were 89.1 (70.8-99.6) and 84.1 (69.0-93.9), respectively. The quality control stage identified most low performance segments. For the 50% of segments with highest quality scores, the median per-segment and per-patient F1-scores were 100.0 (90.9-100.0) and 94.3 (86.5-97.8). The proposed algorithm could allow reliable, quality-conditioned feedback on ventilation in the challenging scenario of continuous manual CPR in OHCA.