Mechanical devices in cardiac arrest.

30 Pages·2012·5.24 MB·English

Mechanical Devices in Cardiac Arrest

Kjetil Sunde, MD, PhD, FERC

Professor Surgical ICU Ullevål,

Department of Anaesthesiology,
Division of Emergencies and Critical Care,
Oslo University Hospital,
Norway

COI : None
Cardiac arrest
• CPR + early defibrillation  save more lives!
• This alone does not always help!
Reality during ALS in cardiac arrest....
Poor quality CPR
- too shallow chest compressions
 poor outcome
- frequent pauses
- hyperventilation

Sunde, Wik, Abella, Valenzuela, van Alem, Edelson, Aufderheide.......
?
+ fatigue over time…
Historical CPR devices….
Devices should:

- improve vital organ blood flow

- feasible, practical, easy to use
During CPR - Mechanical CPR
Quality of ACLS
- mechanical vs manual CPR
Sunde et al, Resuscitation 1997
Mechanical CPR
LUCAS
- piston based
- suction-cup
- now electrically (or battery)
powered

Experimental studies:
Rubertsson et al: improved haemodynamics vs manual CPR Resuscitation 2005
Randomised trials:
Axelsson et al: no difference in survival vs manual CPR Resuscitation 2006
PI: Professor Sten Rubertsson (Uppsala)
- inclusion will end 31/8 2012 (after 4 years)
- ca 2500 pts
- 6 sites in Sweden (Gävle, Uppsala, Västerås and Malmö),
1 site UK (Dorset)
1 site the Netherlands (Utrecht)·
Mechanical CPR
AUTOPULSE
- Load distributing band around the chest
- squeezes the entire chest
- battery driven
Experimental studies:
Halperin et al: improved haemodynamics vs manual CPR JACC 2004
Randomised trials:
Hallstrom et al: worse neurological outcomes vs manual CPR JAMA 2006
(the ASPIRE trial – multicenter)
Autopulse, non RCTs
AutoPulse® Manual OR, CI 95% p

ROSC 39% 29% .003
Casner M et al. Prehosp Emerg
Care 2005
Survival to ER 29% 19% 1.7, 1.1-2.8 .02

Swanson M et al. Circulation 2005
Discharged 10% 3% .0001

Ong MEH et al. JAMA 2006
Discharged ICU 21.8%
Krep H et al. Resuscitation 2007