Use Of Mechanical Chest Compression Devices Research Articles

Prehospital factors associated with out-of-hospital cardiac arrest outcomes in a metropolitan city: a 4-year multicenter study

BackgroundPrehospital factors play a vital role in out-of-hospital cardiac arrest (OHCA) survivability, and they vary between countries and regions. We investigated the prehospital factors associated with OHCA outcomes in a single metropolitan city in the Republic of Korea.MethodsThis study included adult medical OHCA patients enrolled prospectively, using data from the citywide OHCA registry for patients registered between 2018 and 2021. The primary outcome was survival to hospital discharge. Multivariable logistic regression analysis was conducted to determine the factors associated with the study population’s clinical outcomes, adjusting for covariates. We performed a sensitivity analysis for clinical outcomes only for patients without prehospital return of spontaneous circulation prior to emergency medical service departure from the scene.ResultsIn multivariable logistic regression analysis, older age (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.95–0.97), endotracheal intubation (adjusted odds ratio [aOR] 0.29; 95% [CIs] 0.17–0.51), supraglottic airway (aOR 0.29; 95% CI 0.17–0.51), prehospital mechanical chest compression device use (OR 0.13; 95% CI 0.08–0.18), and longer scene time interval (OR 0.96; 95% CI 0.93–1.00) were negatively associated with survival. Shockable rhythm (OR 24.54; 95% CI 12.99–42.00), pulseless electrical activity (OR 3.11; 95% CI 1.74–5.67), and witnessed cardiac arrest (OR 1.59; 95% CI 1.07–2.38) were positively associated with survival. In the sensitivity analysis, endotracheal intubation, supraglottic airway, prehospital mechanical chest compression device use, and longer scene time intervals were associated with significantly lower survival to hospital discharge.ConclusionsRegional resuscitation protocol should be revised based on the results of this study, and modifiable prehospital factors associated with lower survival of OHCA should be improved.

Abstract 136: The Effect Of Mechanical Chest Compression Device On Survival After Out-of-hospital Cardiac Arrest According To Patient Transport Interval: A Multicenter Observational Study

Objectives: This study aimed to investigate the effect of mechanical chest compression device (MCPRD) on patients with OHCA according to patient transport interval (PTI). We hypothesized that MCPRD is effective on survival with prolonged PTI compared with manual chest compression (non-MCPRD). Methods: This cross-sectional multicenter observational study used the Korean Cardiac Arrest Research Consortium registry data from 2015 to 2019. Emergency medical service (EMS) treated OHCAs presumed of cardiac etiology without return of spontaneous circulation (ROSC) at scene were included. Exposure was prehospital MCPRD use and PTI. The main outcome was survival to admission. PTI was categorized into three groups; short PTI for 0-5 minutes, intermediate for 6-10 minutes and long PTI for over 10 minutes, respectively. Multivariable logistic regression was performed to estimate the adjusted odds ratios (AORs) and its’ corresponding 95% confidence intervals (95% CI) for the effect of MCPRD compared with manual compression on outcome. Interaction of PTI on the effect of MCPRD on outcome were tested. To control for selection bias and confounding factors, propensity score (PS) matched cohort was extracted. PS score for each patient to receive MCPRD was estimated using a multivariable logistic regression model. To reduce the standard error of MCPRD on outcomes, a two-to-one propensity score matched cohort was extracted. Results: For unmatched cohort, a total of 3,530 patients were eligible and after PS matching, a total of 2,049 patients were eligible for the analysis. The MCPRD was applied at 19.3% of all unmatched cohort. After adjusting for potential confounders, the AOR of MCPRD for survival to admission was 1.36 (95% CI 1.07-1.72) for unmatched cohort and 1.37 (95% CI 1.06-1.78) for PS matched cohort. Interaction according to PTI on the effect of MCPRD was significant at prolonged PTI on both cohorts; AOR 1.60 (95% CI 1.06-2.42) for unmatched cohort and AOR 1.60 (95% CI 1.06-2.42) for PS matched cohort, respectively. Conclusion : For patients with OHCA with PTI longer than 10 minutes, MCPRD use showed a significant survival benefit compared with manual chest compressions. Further studies are needed to evaluate the appropriate use of MCPRD in special situations.

46 The Effect of Mechanical Chest Compression Device on Survival After Out-of-Hospital Cardiac Arrest According to Patient Transport Interval: A Multi-center Observational Study

46 The Effect of Mechanical Chest Compression Device on Survival After Out-of-Hospital Cardiac Arrest According to Patient Transport Interval: A Multi-center Observational Study

What are ambulance crews' experiences of using a mechanical chest compression device for out-of-hospital resuscitation? A constructivist qualitative study utilising online focus groups.

Mechanical chest compression devices (MCCDs) provide chest compressions mechanically to a person in cardiac arrest. Those chest compressions would usually be provided manually. Previous studies into the use of MCCDs have focused on the quantitative outcomes, with little emphasis on the qualitative experiences of those using MCCDs. To collect and report ambulance crews' experiences of using MCCDs for out-of-hospital resuscitation attempts. The philosophical approach was constructivist, the methodology qualitative and the data collection method online focus groups. Convenience sampling was used to recruit participants who met the inclusion criteria, which broadly were to have experience of using MCCDs for out-of-hospital resuscitation. There have been two types of MCCD used locally. Participants were included regardless of which type of device they had experience of. Similarly, participants were included whether they had active or passive experience of the devices. The focus groups were recorded, fully transcribed and then analysed using constant comparison. Four selective codes emerged. These were factors directly affecting ambulance crew members; practicalities of a resuscitation attempt; ambulance crew members' perceptions, experiences and thoughts; negatives of MCCDs. The main perceptions arising from the participants' discussion in this work were that MCCD use could potentially provide psychological protection to ambulance crew members when reflecting on resuscitation attempts, and participants felt there is an overall reduction of cognitive load for ambulance crew members when using MCCDs for resuscitation attempts. There were particularly timely benefits expressed of MCCDs easing the physical fatigue of a resuscitation attempt when responding wearing personal protective equipment, as has been required during the COVID-19 pandemic. MCCDs were felt to be of benefit when transporting a patient in cardiac arrest but differences were expressed as to whether the LUCAS-2 in particular helps or hinders extrication of a patient.

Neurologic outcomes of prehospital mechanical chest compression device use during transportation of out-of-hospital cardiac arrest patients: a multicenter observational study.

ObjectiveHigh-quality cardiopulmonary resuscitation with chest compression is important for good neurologic outcomes during out-of-hospital cardiac arrest (OHCA). Several types of mechanical chest compression devices have recently been implemented in Korean emergency medical services. This study aimed to identify the effect of prehospital mechanical chest compression device use on the outcomes of OHCA patients.MethodsWe retrospectively analyzed data drawn from the regional cardiac arrest registry in Daegu, Korea. This registry prospectively collected data from January 2017 to December 2020. Patients aged 18 years or older who experienced cardiac arrest presumed to have a medical etiology were included. The exposure variable was the use of a prehospital mechanical device during transportation by emergency medical technicians. The outcomes measured were neurologic outcomes and survival to discharge. Logistic regression analysis was used.ResultsAmong 3,230 OHCA patients, 1,111 (34.4%) and 2,119 (65.6%) were managed with manual chest compression and with a mechanical chest compression device, respectively. The mechanical chest compression group showed poorer neurologic outcomes than the manual chest compression group (adjusted odds ratio, 0.12; 95% confidence interval, 0.04–0.33) and decreased survival to discharge (adjusted odds ratio, 0.39; 95% confidence interval, 0.19–0.82) after adjustment for confounding variables.ConclusionPrehospital mechanical chest compression device use in OHCA was associated with poorer neurologic outcomes and survival to discharge compared to manual chest compression.

Impact of the COVID-19 outbreak on adult out-of-hospital cardiac arrest outcomes in Daegu, South Korea: an observational study.

ObjectiveThis study aimed to compare the outcomes of adult out-of-hospital cardiac arrest (OHCA) before and after the coronavirus disease 2019 (COVID-19) outbreak in a large metropolitan city.MethodsThis before-and-after observational study used a prospective citywide OHCA registry. Adult patients with emergency medical service-treated OHCA, with presumed cardiac etiology, pre- and post-COVID-19 outbreak were enrolled. The study period spanned 2 months, starting from February 18, 2020. The control period was 2 months from February 18, 2019. The primary and secondary outcomes were good neurologic outcome and survival to hospital discharge, respectively. The association between the COVID-19 outbreak and OHCA outcomes was assessed using multivariable logistic regression analysis.ResultsThis study analyzed 297 OHCA patients (control period, 145; study period, 152). The bystander cardiopulmonary resuscitation rates were 64.8% and 60.5% during the control and study periods, respectively. Response and on-scene times increased by 2 minutes, supraglottic airway use increased by 35.6%, and mechanical chest compression device use increased by 13% post-COVID-19 outbreak. Good neurologic outcome was significantly lower during the study period in overall OHCAs (adjusted odds ratio, 0.23; 95% confidence interval, 0.05–0.98) and in witnessed OHCAs (adjusted odds ratio, 0.14; 95% confidence interval, 0.02–0.90). No significant difference was found in the survival to hospital discharge of OHCA patients between the two periods. ConclusionDuring the COVID-19 pandemic, the response and on-scene times were longer, and good neurologic outcome was significantly lower than that in the control period.

Interaction Effect Between Prehospital Mechanical Chest Compression Device Use and Post-Cardiac Arrest Care on Clinical Outcomes After Out-Of-Hospital Cardiac Arrest.

Prehospital application of a mechanical chest compression device (MCD) and post-cardiac arrest (PCA) care including coronary reperfusion therapy (CRT) or targeted temperature management (TTM) could affect the clinical outcome in out-of-hospital cardiac arrest (OHCA). This study aimed to assess whether the effect of PCA care including CRT or TTM differs according to prehospital MCD use in patients with OHCA. Adult OHCA cases with a presumed cardiac etiology and with survival to admission from 2016 to 2017 were enrolled from the Korean nationwide OHCA registry. The main exposures were CRT and TTM during PCA care. The primary outcome was good neurologic recovery defined by a cerebral performance category score of 1 or 2 at hospital discharge. We conducted interaction analyses between MCD use and PCA care including CRT or TTM. Four thousand three hundred sixty-six OHCA cases were enrolled and 7.9% underwent MCD application. TTM and CRT were performed in 11.2% and 17.9% of the study population. In the interaction analysis, the adjusted odds ratios of TTM and CRT for good neurologic recovery were 2.41 (1.90-3.06) and 3.40 (2.79-4.14) in patients without MCD use and 1.89 (0.97-3.68), and 1.54 (0.79-3.01) in patients with MCD use. The effect of PCA care on neurologic outcomes was different according to MCD use in OHCA. The association of good neurologic outcome and PCA care was not observed in the prehospital MCD use group compared with that in the MCD nonuse group.

Metrics of mechanical chest compression device use in out-of-hospital cardiac arrest.

ObjectiveThe quality of cardiopulmonary resuscitation (CPR) affects outcomes from cardiac arrest, yet manual CPR is difficult to administer. Although mechanical CPR (mCPR) devices offer high quality CPR, only limited data describe their deployment, their interaction with standard manual CPR (sCPR), and the consequent effects on chest compression continuity and patient outcomes. We sought to describe the interaction between sCPR and mCPR and the impact of the sCPR‐mCPR transition upon outcomes in adult out‐of‐hospital cardiac arrest (OHCA).MethodsWe analyzed all adult ventricular fibrillation OHCA treated by the Anchorage Fire Department (AFD) during calendar year 2016. AFD protocols include the immediate initiation of sCPR upon rescuer arrival and transition to mCPR, guided by patient status. We compared CPR timing, performance, and outcomes between those receiving sCPR only and those receiving sCPR transitioning to mCPR (sCPR + mCPR).ResultsAll 19 sCPR‐only patients achieved return of spontaneous circulation (ROSC) after a median of 3.3 (interquartile range 2.2–5.1) minutes. Among 30 patients remaining pulseless after sCPR (median 6.9 [5.3–11.0] minutes), transition to mCPR occurred with a median chest compression interruption of 7 (5–13) seconds. Twenty‐one of 30 sCPR + mCPR patients achieved ROSC after a median of 11.2 (5.7–23.8) additional minutes of mCPR. Survival differed between groups: sCPR only 14/19 (74%) versus sCPR + mCPR 13/30 (43%), P = 0.045.ConclusionIn this series, transition to mCPR occurred in patients unresponsive to initial sCPR with only brief interruptions in chest compressions. Assessment of mCPR must consider the interactions with sCPR.

Mechanical chest compression device use in patients in a non-shockable rhythm at in-hospital cardiac arrest: a multi-centre feasibility randomised controlled trial (COMPRESS-RCT)

Mechanical chest compression device use in patients in a non-shockable rhythm at in-hospital cardiac arrest: a multi-centre feasibility randomised controlled trial (COMPRESS-RCT)

Assessment of CPR interruptions from transthoracic impedance during use of the LUCAS™ mechanical chest compression system

BackgroundQuality of cardiopulmonary resuscitation (CPR) is a key determinant of outcome following out-of-hospital cardiac arrest (OHCA). Recent evidence shows manual chest compressions are typically too shallow, interruptions are frequent and prolonged, and incomplete release between compressions is common. Mechanical chest compression systems have been developed as adjuncts for CPR but interruption of CPR during their use is not well documented. AimAnalyze interruptions of CPR during application and use of the LUCAS™ chest compression system. Methods54 LUCAS 1 devices operated on compressed air, deployed in 3 major US emergency medical services systems, were used to treat patients with OHCA. Electrocardiogram and transthoracic impedance data from defibrillator/monitors were analyzed to evaluate timing of CPR. Separately, providers estimated their CPR interruption time during application of LUCAS, for comparison to measured application time. ResultsIn the 32 cases analyzed, compressions were paused a median of 32.5s (IQR 25–61) to apply LUCAS. Providers’ estimates correlated poorly with measured pause length; pauses were often more than twice as long as estimated. The average device compression rate was 104/min (SD 4) and the average compression fraction (percent of time compressions were occurring) during mechanical CPR was 0.88 (SD 0.09). ConclusionsInterruptions in chest compressions to apply LUCAS can be <20s but are often much longer, and users do not perceive pause time accurately. Therefore, we recommend better training on application technique, and implementation of systems using impedance data to give users objective feedback on their mechanical chest compression device use.

Mechanical chest-compression devices: current and future roles

It is recognized that the quality of cardiopulmonary resuscitation (CPR) is an important predictor of outcome from cardiac arrest yet studies consistently demonstrate that the quality of CPR performed in real life is frequently sub-optimal. Mechanical chest-compression devices provide an alternative to manual CPR. This review will consider the evidence and current indications for the use of these devices. Physiological and animal data suggest that mechanical chest-compression devices are more effective than manual CPR. However, there is no high quality evidence showing improved outcomes in humans. There are specific circumstances where it may not be possible to perform manual CPR effectively for example, during ambulance transport to hospital, en-route to and during cardiac catheterization, prior to organ donation and during diagnostic imaging where using these devices may be advantageous. There is insufficient evidence to recommend the routine use of mechanical chest-compression devices. There may be specific circumstances when CPR is difficult or impossible where mechanical devices may play an important role in maintaining circulation. There is an urgent need for definitive clinical and cost effectiveness trials to confirm or refute the place of mechanical chest-compression devices during resuscitation.