How Safe is Mechanical CPR?

    NextPrevious

    How Safe is Mechanical CPR?

    Question – How safe is mechanical CPR compared to manual CPR?

    There are two devices used for mechanical CPR – the AutoPulse and LUCAS – neither of which has been demonstrated to show a survival benefit over manual CPR in recent studies (CIRC, LINC, PARAMEDIC). Could these devices be causing more injuries compared to manual compressions? Enter a recently published study from the European Heart Journal.

    Koster et al. 2017* was a noninferiority safety study that randomized patients to the Autopulse, Lucas or manual compressions.

    Population – patients with either in-hospital cardiac arrest or out-of-hospital cardiac arrest that received manual CPR in the ED. Patients were recruited from Nov 2008-May 2014. Exclusion criteria included traumatic etiology, pediatric patients, patients that already had a mechanical compression device applied by ALS crew, ROSC before application of device.

    Intervention – Mechanical CPR

    Comparison – Manual CPR

    Outcome – serious injuries (visceral organs, large vessels, vertebrae) as assessed blind by post-mortem CT, autopsy or clinical course. These injuries were classified into 3 categories:

    • 1) life-threatening (expected to interfere with cardiac or respiratory function, or exsanguination > 800 mL)
    • 2) serious – injury would require repair or would be expected to prolong hospitalization
    • 3) insignificant

    Results: Autopulse (n=115), LUCAS (n=122), Manual Control (n=137)

    • The LUCAS device had similar rates of life-threatening or serious visceral damage compared to manual CPR (7.4% vs 6.3% respectively). There was a trend toward more life-threatening or serious outcomes with the use of the Autopulse (11.7%) but this was not significant. Some of these injuries included pneumothorax, pulmonary contusion, liver rupture, air embolism.
    • 3 patients had death attributable to the resuscitation itself. Two patients with the LUCAS had liver rupture with massive hemorrhage, and there was one AutoPulse patient found to have a tension PTX + air embolism.
    • Most did not survive resuscitation (Autopulse: 62.6%, LUCAS 65.6%, Manual CPR 50.4%), and more of the manual CPR group (49.6%) were admitted to the ICU after resuscitation. The study was underpowered to study survival, so no P values were given.

    Conclusions – Mechanical CPR was not more likely to produce significant injuries when compared to manual CPR. There was a trend toward more significant injuries with the use of AutoPulse.

    *Primary Author received funding from Physio-Control (Creator of LUCAS) and Zoll-Medical (Creator of AutoPulse).

    Sources:

    1. Koster et. al 2017 – Safety of Mechanical Chest Compression Devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority
    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • ED Postpartum Hemorrhage

      So you’re in the ED and a G9P8 patient at 40w2d rolls in with contractions every 3 minutes. Before sending the patient upstairs you do a brief examination and you see this…   You deliverRead more

    • Lewis Leads & Invisible P’s

      You ever have a tough time visualizing P waves on EKGs? Have no fear, a Lewis Lead EKG might just be the thing you need! The Lewis Lead (aka S5) is a modified EKG obtained in a mannerRead more

    • Head Scratcher of a Head CT?

      Hey there guys and gals and welcome back to my channel! If you’re like me and TERRIBLE at reading your own imaging studies, settle in for a quick 20 minute run down for all thoseRead more

    • Central Line Troubleshooting. Beyond the Basics.

      Needle, wire, nick, dilate, catheter. Sounds simple right? However, simple doesn’t always mean easy. Placing a central line on a mannequin can be much easier than the 250lb ESRD patient with peripheral vascular disease andRead more

    • Narcan Overdose. Too Much of a Good Thing?

      What do smack, dragon, horse, salt, brown sugar, china white, and black pearl have in common? That’s right… they are all nicknames for heroin. We all know that Naloxone (Narcan) is a useful antidote inRead more

    • Health Information Exchange: Quest for the Omni-Chart.

      Have you ever opened a chart of a very sick or obtunded patient, only to find it completely blank? Of course you have…probably at some point today. The minor panic that having to find vitalRead more

    • Clinical Decision Support…your daily helper.

      Continuing with the theme of clinical informatics, today we will touch on the topic of Clinical Decision Support Systems (CDSS), or sometimes just called Clinical Decision Support (CDS). The basic premise of clinical decision supportRead more

    • What Is Clinical Informatics?

      If you loved the super sexy topic of cerumen impaction yesterday…Well, hold on to your socks, because today we will continue our rousing educational foray by tackling the riveting question: What is Clinical Informatics? ShallRead more

    NextPrevious