Mechanical Cardiopulmonary Resuscitation Devices Research Articles

Characteristics and outcomes of out-of-hospital cardiac arrest in a hilly area: Utstein Registry data from the Nagasaki Medical Region, Japan.

To analyze characteristics and investigate prognostic indicators of out-of-hospital cardiac arrest (OHCA) in a hilly area in Japan. A retrospective population-based study was conducted using the Utstein Registry for 4280 OHCA patients in the Nagasaki Medical Region (NMR) registered over the 10-year period from 2011 to 2020. The main outcome measure was a favorable cerebral performance category (CPC 1-2). Sites at which OHCA occurred were classified into "sloped places (SPs)" (not easily accessible by emergency medical services [EMS] personnel due to slopes) and "accessible places (APs)" (EMS personnel could park an ambulance close to the site). The characteristics and prognosis based on CPC were compared between SPs and APs, and multivariable analysis was performed. No significant improvement in prognosis occurred in the NMR from 2011 to 2020. Prognosis in SPs was significantly worse than that in APs. However, multivariable analysis did not identify SP as a prognostic indicator. The following factors were associated with survival and CPC 1-2: age group, witness status, first documented rhythm, bystander-initiated cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, use of mechanical CPR (m-CPR) device or esophageal obturator airway (EOA), and year. Both m-CPR and EOA use were associated with a poor prognosis. In a hilly area, OHCA patients in SPs had a worse prognosis than those in APs, but SPs was not significantly associated with prognosis by multivariable analysis. Interventions to increase bystander-initiated CPR and AED use could potentially improve outcomes of OHCA in the NMR.

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.

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.

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.

Comparison of prehospital resuscitation quality during scene evacuation and early ambulance transport in out-of-hospital cardiac arrest between residential location and non-residential location

BackgroundHigh-quality prehospital cardiopulmonary resuscitation (CPR) is important for out-of-hospital cardiac arrest (OHCA). We aimed to evaluate prehospital CPR quality during scene evacuation and early ambulance transport in patients with OHCA according to the type of cardiac arrest location. MethodsThis retrospective observational cohort study enrolled patients with non-traumatic adult OHCA in Seoul between July 2020 and March 2022. Prehospital CPR quality data extracted from defibrillators were merged with the national OHCA database. The location of cardiac arrest was categorized into two groups (residential and non-residential). CPR quality indices including no-flow (any pause >1.5 s) fraction were compared according to the type of arrest location at each minute of EMS scene evacuation and early ambulance transport (5 min prior to 5 min after ambulance departure). ResultsA total of 1,222 OHCAs were enrolled in the final analysis after serial exclusion. A total of 966 OHCAs (79.1%) occurred in the residential areas. The CPR quality deteriorated during the scene evacuation in both location type. The mean no-flow fractions were significantly higher in residential places than in non-residential places. The mean proportion of adequate compression depth and rate was lower in cardiac arrests in residential places. The discrepancy in EMS CPR quality during scene evacuation was more prominent when mechanical CPR devices were not used. ConclusionDeterioration of CPR quality was observed just before and during early ambulance transport, especially when the cardiac arrest location was a residential area or when only manual CPR was provided.

Retrospective Comparison of Prehospital Sustained Return of Spontaneous Circulation (ROSC) Rates Within a Single Basic Life Support Jurisdiction Using Manual vs Lund University Cardiac Assist System (LUCAS-2) Mechanical Cardiopulmonary Resuscitation.

ObjectiveSeveral studies have examined the impact of mechanical cardiopulmonary resuscitation (CPR) devices among multi-jurisdictional emergency medical services (EMS) systems; however, the variability across such systems can inject bias and confounding variables. We focused our investigation on the effect of introducing the Lund University Cardiac Assist System 2 (LUCAS-2) into a single basic life support (BLS) fire department first response jurisdiction served by a single private advanced life support (ALS) agency, hypothesizing that the implementation of the device would increase prehospital return of spontaneous circulation (ROSC) rates as compared with manual CPR. MethodsA retrospective observational analysis of adult non-traumatic prehospital cardiac arrest ALS agency records was conducted. Descriptive statistics were computed, and logistic regression was used to assess the impact of CPR method, response time, age, gender, CPR initiator, witnessed status, automated external defibrillator (AED) initiator, and presence of an initial shockable rhythm on ROSC rates. A Chi-square analysis was used to compare ROSC rates among compression modalities both before and after the implementation of LUCAS-2 on July 1, 2011. ResultsFrom an initial dataset of 857 cardiac arrest records, only 264 (74 pre-LUCAS period, 190 LUCAS-2 period) met inclusion criteria for the primary objective. The ROSC rates were 29.7% (22/74) and 29.5% (56/190), respectively, for manual-only and LUCAS-assisted CPR (p=0.9673). Logistic regression revealed a significant association between ROSC and two of the independent variables: arrest witnessed (OR 3.104; 95% CI 1.896-5.081; p<0.0001) and initial rhythm shockable (OR 2.785; 95% CI 1.492-5.199; p<0.0013). ConclusionsAnalyses support the null hypothesis that there is no difference in prehospital ROSC rates among adult non-traumatic cardiac arrest patients when comparing mechanical-assisted and manual-only CPR. These results are consistent with other larger multi-jurisdictional mechanical CPR studies. Systems with limited personnel might consider augmenting their resuscitations with a mechanical CPR device, although cost and system design should be factored into the decision. Secondary analysis of independent variables suggests that prehospital cardiac arrest patients with a witnessed arrest or an initial rhythm that is shockable have a higher likelihood of attaining ROSC. The power of our primary objective was limited by the sample size. Additionally, we were not able to adequately assess the quality of CPR among the two comparison groups with a lack of consistent end-tidal carbon dioxide (EtCO2) data.

Objective performance of emergency medical technicians in the use of mechanical cardiopulmonary resuscitation compared with subjective self-evaluation: a cross-sectional, simulation-based study

ObjectiveTo evaluate the subjective and objective resuscitation performance of emergency medical technicians (EMTs) using mechanical cardiopulmonary resuscitation (MCPR) devices.Design and settingThis was a cross-sectional simulation-based study where participants installed the...

Comparison between Prehospital Mechanical Cardiopulmonary Resuscitation (CPR) Devices and Manual CPR for Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.

In pre-hospital settings, efficient cardiopulmonary resuscitation (CPR) is challenging; therefore, the application of mechanical CPR devices continues to increase. However, the evidence of the benefits of using mechanical CPR devices in pre-hospital settings for adult out-of-hospital cardiac arrest (OHCA) is controversial. This meta-analysis compared the effects of mechanical and manual CPR applied in the pre-hospital stage on clinical outcomes after OHCA. Cochrane Library, PubMed, Embase, and ClinicalTrials.gov were searched from inception until October 2021. Studies comparing mechanical and manual CPR applied in the pre-hospital stage for survival outcomes of adult OHCA were eligible. Data abstraction, quality assessment, meta-analysis, trial sequential analysis (TSA), and grading of recommendations, assessment, development, and evaluation were conducted. Seven randomized controlled and 15 observational studies were included. Compared to manual CPR, pre-hospital use of mechanical CPR showed a positive effect in achieving return of spontaneous circulation (ROSC) and survival to admission. No difference was found in survival to discharge and discharge with favorable neurological status, with inconclusive results in TSA. In conclusion, pre-hospital use of mechanical CPR devices may benefit adult OHCA in achieving ROSC and survival to admission. With low certainty of evidence, more well-designed large-scale randomized controlled trials are needed to validate these findings.

Prognostic Impact of In-Hospital Use of Mechanical Cardiopulmonary Resuscitation Devices Compared with Manual Cardiopulmonary Resuscitation: A Nationwide Population-Based Observational Study in South Korea.

Background and Objectives: This study analyzed the prognostic impact of mechanical cardiopulmonary resuscitation (CPR) devices in out-of-hospital cardiac arrest (OHCA) patients, in comparison to manual CPR. Materials and Methods: This study was a nationwide population-based observational study in South Korea. Data were retrospectively collected from 142,905 OHCA patients using the South Korean Out-of-Hospital Cardiac Arrest Surveillance database. We included adult OHCA patients who received manual or mechanical CPR in the emergency room. The primary outcome was survival at discharge and the secondary outcome was sustained return of spontaneous circulation (ROSC). Statistical analysis included propensity score matching and multivariate logistic regression. Results: A total of 19,045 manual CPR and 1125 mechanical CPR cases (671 AutoPulseTM vs. 305 ThumperTM vs. 149 LUCASTM) were included. In the matched multivariate analyses, all mechanical CPR devices were associated with a lower ROSC than that of manual CPR. AutoPulseTM was associated with lower survival in the multivariate analysis after matching (aOR with 95% CI: 0.57 (0.33–0.96)), but the other mechanical CPR devices were associated with similar survival to discharge as that of manual CPR. Witnessed arrest was commonly associated with high ROSC, but the use of mechanical CPR devices and cardiac origin arrest were associated with low ROSC. Only target temperature management was the common predictor for high survival. Conclusions: The mechanical CPR devices largely led to similar survival to discharge as that of manual CPR in OHCA patients; however, the in-hospital use of the AutoPulseTM device for mechanical CPR may significantly lower survival compared to manual CPR.

A Comparison Review of Mechanical Cardiopulmonary Resuscitation Vs Manual Cardiopulmonary Resuscitation

Background: Cardiopulmonary resuscitation (CPR) is a lifesaving intervention performed by healthcare workers in the event of cardiac arrest. In recent years, many mechanical devices have been developed to perform quality compressions in place of manual chest compressions in an attempt to sustain quality CPR, as the rescuer will tire, and CPR quality will diminish. With the rise of mechanical cardiopulmonary resuscitation devices (LUCAS, Zoll AutoPulse) making mechanical CPR a realistic and practical treatment option, it now must be determined whether or not mechanical CPR leads to better outcomes in patients that have been successfully resuscitated in comparison to patients having been resuscitated by manual compressions, as is seen in traditional CPR. Purpose: The purpose of the review was to compare long-term outcomes of patients receiving mechanical cardiopulmonary resuscitation versus manual chest compressions. Method: This is a systematic review of the nursing-focused literature regarding the complications and long-term outcomes of patients receiving both manual and mechanical cardiopulmonary resuscitation. This review examined evidence-based studies of both methods to compare findings. Findings: This review found achievement of return of spontaneous circulation (ROSC), complications, and chest compression quality, that pertained to the outcomes of patients following cardiac arrest. No significant difference was noted in the outcomes. Conclusion: At this time, mechanical CPR has more benefit to the team of rescuers than to the patient receiving CPR, as it reduces the number of people needed to make resuscitation efforts and reduces loss of compression quality from fatigued rescuers. However, mechanical CPR was not found to have better patient outcomes when compared to manual CPR in cases of out-of-hospital cardiac arrests.

Effect of Acute Exposure to Altitude on the Quality of Chest Compression-Only Cardiopulmonary Resuscitation in Helicopter Emergency Medical Services Personnel: A Randomized, Controlled, Single-Blind Crossover Trial.

BackgroundHelicopter emergency medical services personnel operating in mountainous terrain are frequently exposed to rapid ascents and provide cardiopulmonary resuscitation (CPR) in the field. The aim of the present trial was to investigate the quality of chest compression only (CCO)‐CPR after acute exposure to altitude under repeatable and standardized conditions.Methods and ResultsForty‐eight helicopter emergency medical services personnel were divided into 12 groups of 4 participants; each group was assigned to perform 5 minutes of CCO‐CPR on manikins at 2 of 3 altitudes in a randomized controlled single‐blind crossover design (200, 3000, and 5000 m) in a hypobaric chamber. Physiological parameters were continuously monitored; participants rated their performance and effort on visual analog scales. Generalized estimating equations were performed for variables of CPR quality (depth, rate, recoil, and effective chest compressions) and effects of time, altitude, carryover, altitude sequence, sex, qualification, weight, preacclimatization, and interactions were analyzed. Our trial showed a time‐dependent decrease in chest compression depth (P=0.036) after 20 minutes at altitude; chest compression depth was below the recommended minimum of 50 mm after 60 to 90 seconds (49 [95% CI, 46–52] mm) of CCO‐CPR.ConclusionsThis trial showed a time‐dependent decrease in CCO‐CPR quality provided by helicopter emergency medical services personnel during acute exposure to altitude, which was not perceived by the providers. Our findings suggest a reevaluation of the CPR guidelines for providers practicing at altitudes of 3000 m and higher. Mechanical CPR devices could be of help in overcoming CCO‐CPR quality decrease in helicopter emergency medical services missions.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT04138446.

Abstract 8941: Efficacy and Safety of Mechanical versus Manual Compression in Cardiac Arrest and Cardiogenic Shock Patients

Introduction: Mechanical chest compression (MCC) provides consistent pressure and timing of each chest compression in line with latest evidenced-based practice. However, there has few evidence about the effectiveness of the mechanical device compared with manual chest compression. Furthermore, few studies focused on cardiogenic shock and cardiac arrest related to heart disease. Hypothesis: The aim in this study is to assess the effectiveness and safety of resuscitation strategies using MCC versus resuscitation strategies using standard manual chest compressions in patients with out of hospital cardiogenic shock and cardiac arrest due to heart disease. Methods: We conducted a retrospective observational study of comparing the outcomes of mechanical and manual chest compressions at our hospital. A total of 69 consecutive patients with out of hospital cardiogenic shock and cardiac arrest were enrolled between April 2014 and May 2018. 39 patients of them received only manual cardiopulmonary resuscitation (CPR) and 30 utilized a mechanical CPR device (LUCAS® Lund University Cardiac Arrest System, USA) during the resuscitation. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual (manual group) and mechanical compressions (MCC group). Results: There was no significant difference in age, gender, the rate of bystander CPR, and arterial blood gases at baseline. No differences were found for the rate of ROSC and 30-day survival between two groups (manual group 42.8% vs MCC group 50.1% p=0.13). However, MCC group had significantly higher rate of bleeding events than manual group. In addition, fifty-four patients of them were treated for cardiac arrest or refractory cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Among patients underwent VA-ECMO, the rate of 30-day survival was significantly lower in MCC group. (manual group 26.8% vs MCC group 39.1% p=0.014). Conclusions: This study showed that mechanical chest compression in cardiac arrest and cardiogenic shock increased bleeding events than manual chest compression. Furthermore, in the patients underwent ECMO, the use of mechanical chest compression might be associated with higher mortality.

Out-of-hospital cardiac arrest due to refractory pulseless ventricular tachycardia and/or ventricular fibrillation

Abstract Background Survival rates for out-of-hospital cardiac arrest (OOHCA) are extremely low and neurologic recovery is poor. Extracorporeal cardiopulmonary resuscitation (ECPR), which combines extracorporeal membrane oxygenation (ECMO) with cardiopulmonary resuscitation (CPR), has emerged as a viable strategy to improve outcomes in OOHCA. A collaborative ECPR program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire Emergency Medical Services (EMS). Purpose Outcomes for patients who present as an ECPR alert from the field, but did not meet predefined criteria for placement of extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL) is described. Methods Between September 15, 2017 and October 12, 2019, 50 subjects presented as an ECPR alert for OOHCA secondary to pulseless VT/VF refractory to defibrillation. All subjects were placed on an automated CPR device prior to transfer to the CCL. From these 50 individuals, 28 (56%) did not meet prespecified laboratory criteria (lactate ≤15 mg/dL, partial pressure of oxygen (PaO2) ≥50 mm Hg, end-tidal carbon dioxide (ETCO2) of ≥10) and did not have a shockable rhythm in the CCL, thus ECMO was not placed and usual care for cardiac arrest was administered. Results Nine (32%) of the 28 patients achieved return of spontaneous circulation (ROSC), while the remaining 19 (68%) where pronounced deceased in the CCL. All 9 patients who achieved ROSC underwent a coronary angiography with 4 (44%) requiring percutaneous coronary intervention and 4 (44%) requiring an acute mechanical circulatory support device (Impella with 1 change out to ECMO). Of the patients that achieved ROSC, 4 (44%) were discharged from the hospital with good neurologic recovery; the remaining 5 (56%) ultimately expired during the hospitalization. From the initial 28 patient cohort, there were 4 (14%) patients discharged alive. Patients who achieved ROSC as compared to no ROSC were found on presentation in the CCL to have a significantly lower lactate (12.3±4.3 vs 16.2±3.6, respectively; p=0.03) and greater PaO2 (145±125 vs 47±9, respectively; p=0.01); there was no significant differences between groups in ETCO2, age or emergency services dispatch to CCL arrival time. Conclusion This study demonstrates that an ECPR program for OOHCA due to refractory VT/VF may provide benefit to patients that do not meet the predefined criteria for ECMO. This may be due to minimizing no flow/low flow time by early recognition and ongoing CPR en route to the CCL by a skilled EMS team, high efficiency citywide expedited transport/triage, the provision of high quality uninterrupted chest compressions using the mechanical CPR device during transport, and the care provided by highly trained multidisciplinary team members in the CCL. Funding Acknowledgement Type of funding sources: None.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.

Resuscitative endovascular balloon occlusion of the aorta vs epinephrine in the treatment of non-traumatic cardiac arrest in swine

BackgroundThe administration of epinephrine in the management of non-traumatic cardiac arrest remains recommended despite controversial effects on neurologic outcome. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) could be an interesting alternative. The aim of this study was to compare the effects of these 2 strategies on return of spontaneous circulation (ROSC) and cerebral hemodynamics during cardiopulmonary resuscitation (CPR) in a swine model of non-traumatic cardiac arrest.ResultsAnesthetized pigs were instrumented and submitted to ventricular fibrillation. After 4 min of no-flow and 18 min of basic life support (BLS) using a mechanical CPR device, animals were randomly submitted to either REBOA or epinephrine administration before defibrillation attempts. Six animals were included in each experimental group (Epinephrine or REBOA). Hemodynamic parameters were similar in both groups during BLS, i.e., before randomization. After epinephrine administration or REBOA, mean arterial pressure, coronary and cerebral perfusion pressures similarly increased in both groups. However, carotid blood flow (CBF) and cerebral regional oxygenation saturation were significantly higher with REBOA as compared to epinephrine administration (+ 125% and + 40%, respectively). ROSC was obtained in 5 animals in both groups. After resuscitation, CBF remained lower in the epinephrine group as compared to REBOA, but it did not achieve statistical significance.ConclusionsDuring CPR, REBOA is as efficient as epinephrine to facilitate ROSC. Unlike epinephrine, REBOA transitorily increases cerebral blood flow and could avoid its cerebral detrimental effects during CPR. These experimental findings suggest that the use of REBOA could be beneficial in the treatment of non-traumatic cardiac arrest.

The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan.

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

Learning Outcomes of an International Training Course on Mechanical Cardiopulmonary Resuscitation Device Use for Emergency Medicine Residents

Background: The present study was conducted to assess the learning outcomes of mechanical cardiopulmonary resuscitation device training course for emergency medicine residents from Laos. The course was part of a collaborative project among Tsukuba University in Japan, the University of Health Sciences in Laos, and Khon Kaen University in Thailand. Objective: To evaluate the learning outcomes a mechanical cardiopulmonary resuscitation device course for emergency medicine residents. Materials and Methods: The cross-sectional study was conducted in emergency medicine residents from Laos who participated in a training course on the use of mechanical cardiopulmonary resuscitation devices, which took place between January and March 2020 at the Srinagarind Hospital emergency department (ED). Assessment exams for individually with standard checklists for Thais’ emergency medicine residents. Results: A total of eight emergency medicine residents from Laos were enrolled. The mean age was 33.7+3.5 years, and 62.5% (n = 5) of the participants were female. We found that participants’ mean score had increased from 4 to 8 points after the training course (p = 0.010). Participants rated the ease of the procedure as 8 out of 10 (1: very difficult). Conclusion: The mechanical cardiopulmonary resuscitation device training course was successful in terms of sharing both medical knowledge and equipment management techniques. Keywords: Internship and Residency, Laos, Cardiopulmonary resuscitation, Emergency medicine

Gender Disparities Among Adult Recipients of Layperson Bystander Cardiopulmonary Resuscitation by Location of Cardiac Arrest in Pan-Asian Communities

Background: Bystander cardiopulmonary resuscitation (BCPR) is a critical component of the ‘chain of survival’ in reducing mortality among out-of-hospital cardiac arrest (OHCA) victims. Inconsistent findings on gender disparities among adult recipients of layperson BCPR have been reported in the literature. We aimed to fill this knowledge gap by investigating the extent of gender disparities in a cross-national setting within Pan-Asian communities. Methods: We utilized data collected from the Pan-Asian Resuscitation Outcomes Study (PAROS), an international, multicenter, prospective study conducted between 2009 and 2018. We included all OHCA cases with non-traumatic arrest etiology transported by emergency medical services and excluded study sites that did not consistently collect information about the location of cardiac arrest. Logistic regression was used to analyze the association between gender and BCPR, stratified by location. Findings: We analyzed a cohort of 56,192 OHCA cases with an overall BCPR rate of 36.2% (20,329/56,192). At public locations, BCPR rate was 31.2% (631/2022) for female and 36.4% (3235/8892) for male OHCA victims; while at home, the rate was 38.3% (6838/17,842) for females and 35.1% (9625/27,436) for males. Controlling for country differences and several factors in multivariable logistic regression, we found females less likely to receive BCPR than males in public locations (odds ratio [OR]=0.89, 95% confidence interval [CI]: 0.70–0.99), but more likely to receive BCPR at home (OR=1.16, 95% CI: 1.11–1.21). Interpretation: In Pan-Asian communities, gender differences exist in adult recipients of BCPR and differ between home and public locations. Funding Statement: The study is supported by grants from the National Medical Research Council (NMRC/CSA/0049/2013) and Laerdal Foundation (20040). Declaration of Interests: MEH Ong reports funding from the ZOLL Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR raining Centre Research Program in Norway. MEH Ong has a licensing agreement and patent filed (Application no: 13/047,348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient. NL and MEH Ong are the co-founders and scientific advisors of TIIM Healthcare, a commercial entity which develops real-time prediction and risk stratification solutions at triage. All other authors have no conflict of interest to declare. Ethics Approval Statement: The study was granted approval from SingHealth Centralised Institutional Review Board and Domain Specific Review Board with waiver of patient informed consent.

Abstract 12985: Efficacy and Safety of Mechanical versus Manual Compression in Cardiac Arrest and Cardiogenic Shock Patients

Introduction: Mechanical chest compression (MCC) provides consistent pressure and timing of each chest compression in line with latest evidenced-based practice. However, there has been no evidence from large randomized trials about the effectiveness of the mechanical device compared with manual chest compression. Furthermore, few studies focused on cardiogenic shock and cardiac arrest related to heart disease. Hypothesis: The aim is to assess the effectiveness and safety of mechanical chest compressions versus manual chest compressions in patients with out of hospital cardiogenic shock and cardiac arrest due to heart disease. Methods: We conducted a retrospective observational study of comparing the outcomes of mechanical and manual chest compressions. A total of 69 consecutive patients with out of hospital cardiogenic shock and cardiac arrest were enrolled between April 2014 and May 2018. 39 patients of them received only manual cardiopulmonary resuscitation (CPR) and 30 utilized a mechanical CPR device. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual (manual group) and mechanical compressions (MCC group). Results: There was no significant difference in age, gender, the rate of bystander CPR and arterial blood gases at baseline. No differences were found for the rate of ROSC and 30-day survival between two groups. However, MCC group had significantly higher rate of bleeding events than manual group. In addition, fifty-four patients of them were treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Among patients underwent VA-ECMO, the rate of 30-day survival was significantly lower in MCC group. (Figure 1). Conclusions: This study showed that mechanical chest compression increased bleeding events than manual chest compression. Furthermore, in the patients underwent ECMO, the use of mechanical chest compression might be associated with higher mortality.

Simulation-Based Up-Training in Response to the COVID-19 Pandemic

The dramatic outbreak of COVID-19 placed unprecedented strain on the critical care workforce of New York City. The enhanced precautions required to safely care for COVID-19 patients impacted the performance of even routine critical care procedures. Meanwhile, staff were stretched to care for exponentially rising case volume as COVID intensive care units (ICUs) expanded. Simulation was used to bridge these gaps-first to familiarize personnel within the Division of Pulmonary and Critical Care with revised COVID-19 care procedures, then to orient noncritical care clinicians volunteering from other specialties for COVID ICU deployment to general critical care and COVID-19 care principles. Using mannequin-based simulation scenarios followed by comprehensive debriefing sessions, simulation participants received high-intensity, high-fidelity training in respiratory failure, circulatory failure, bedside ultrasound, bedside ICU procedures, and elements of COVID-19-specific care. More than 200 physicians and advanced practice practitioners completed simulation training in preparation for deployment, supplementing and enhancing the ICU workforce at a decisive time during the outbreak.