Fresh Perspective on Mechanical CPR – Pearls from ICEM 2014

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Update on Mechanical CPR – 2014

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Hong Kong – ICEM 2014

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  • There is a need for improving CPR quality in all countries as survival rates are poor
      • In Singapore it can take >15 mins for trained rescuers to arrive at the scene of a Cardiac Arrest
      • Survival of CPR falls rapidly from the onset of arrest (see graphs below)
      • Mechanical CPR may improve the quality of CPR (the second link in the so-called chain of survival)
Chain of Survival
Chain of Survival
      • Emergency Medical Systems (EMS) face challenges for transport – both in terms of safety and in terms of the quality of CPR provided in transport – mechanical CPR may help in this respect

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  • Minimal Interruptions to CPR is ideal because it takes multiple compressions to build up a pressure head:

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  • Background of Mechanical CPR
      • Originally perfumed on Dogs (successfully) around 50 years ago
      • Later Piston systems showed no mortality benefit in humans (but some haemodynamic benefit)
  • Data to date has been mixed on modern devices such as the LUCAS and AUTOPULSE
  • One notable 2006 JAMA paper suggested potential HARM from mechanical CPR:

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  • More recent studies have suggested no benefit from the current devices but with some methodological issues
  • The Speakers atICEM suggest that further studies are required due to these issues
    • Clear rules on application of the Mechanical CPR and lack of standardised algorithms
    • Use of intention to treat analysis – may affect results

ICEM 2014

  • Recent Evidence on the various devices includes the following:
      • AUTOPULSE Device
        • CIRC Trial
          • Survival in patients receiving Mechanical CPR has NOT shown benefit in recent trials such as the CIRC Trial (2011).
          • However, the manual CPR in these studies was of higher quality than one would expect.
          • The fraction of effective chest compressions was about the same between groups.
      • LUCAS Device
        • LINC Trial
          • 4-hour survival rate: Mechanical compression group (23.6%) versus the conventional group (23.7%)
          • 6-month survival rate: Mechanical group (8.5%) versus conventional group (8.1%)
          • 6-month good neurologic status (based on Cerebral Performance category of 1 or 2): Mechanical group (99%) versus conventional group (94%)
        • MECCA Trial (Singapore)
          • Provisional results of this as yet unpublished trial were presented:
            • 1189 eligible patients
            • Low levels of survival overall
            • Higher survival in Mechanical CPR group but not statistically significant
      • Using a “Pit Crew” method (Ong 2012) for implementing Mechanical CPR may reduce the time it takes to fit the device and  maximised the time of chest compressions

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Take Homes

  • How do we deliver better chest compressions?
      • Recent reviews of the evidence have suggested that is unclear whether Mechanical CPR has benefit
      • The presenters at ICEM believe that Mechanical CPR may have a role – especially in transporting patients
      • Modern devices may cause less injury compared to older Piston Types
      • Good CPR requires Teamwork and Training regardless of whether human CPR or machine CPR is used
      • Public Education on the importance of early CPR will save lives as Cardiac Arrest is a pre-hospital event with survival likelihood determined by early intervention (CPR and Defibrillation)
Cardiac Arrest is a Prehospital Event
Cardiac Arrest is a Prehospital Event
      • AEDs which are now widely used in public buildings.  In the same way technology such as Mechanical CPR devices may become increasingly available in the pre hospital setting.
      • Mechanical CPR may have a future role despite the disappointing trial data described above
      • Technology is likely to advance and more trials of implementation are required in this area

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Further Listening – Lecture by Marcus Ong (2011)

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