MECHANICAL CHEST

COMPRESSION

DEVICESErica Simon, DO, MHA

Military EMS & Disaster Medicine Fellow

SAUSHEC

Disclaimer

• The view(s) expressed herein are those of the author and

do not reflect the official policy of position of Brooke Army

Medical Center, the U.S. Army Medical Department, the

U.S. Army Office of the Surgeon General, the Department

of the Air Force, the Department of the Army, the

Department of Defense, or the U.S. Government.

• No disclosures.

Objectives

• History

• Devices

• Data

Parsons I, Cox A, Rees P. Military application of mechanical CPR devices: a pressing requirement? J R

Army Med Corps. 2018 Apr 6 [epub ahead of print].

History

Michigan Instruments. “Our History.” Accessed 23 June 2018.

Available from: https://www.michiganinstruments.com/about-

us/history

Michigan Instruments. “Our History.” Accessed 23 June 2018.

Available from: https://www.michiganinstruments.com/about-

us/history

Spectrum Health. “Butterworth Hospital.” Accessed 23 June 2018.

Available from: https://www.spectrumhealth.org/locations/spectrum-

health-hospitals-butterworth-hospital

Devices

• Mechanism: Pneumatic

Piston

• Delivers American Heart

Association Compliant CPR

• Limited Data:1-4

• 4 Single Center Studies:

• Hemodynamic improvement

vs. manual CPR

• No mortality benefit Michigan Instruments. “CPR Machine Models.” Accessed 23

June 2018. Available from:https://www.michiganinstruments.

com/automatic-mechanical-cpr-machines/

Devices

• Mechanism: Pneumatic or

Battery-Powered Piston

• Delivers American Heart

Association Compliant CPR

• Contraindications to use:5

• Patient too small

• Patient > 170 kg

• Pregnant femalesLund University Cardiac Assist

System (LUCAS™)

Parsons I, Cox A, Rees P. Military application of mechanical CPR devices: a

pressing requirement? J R Army Med Corps. 2018 Apr 6 [epub ahead of

print].

Devices

• Mechanism: Battery-powered

Load Distributing Band

• Delivers American Heart

Association Compliant CPR

• Contraindications:6

• Age < 18

Zoll AutoPulse™

Leader Healthcare. “Zoll AutoPulse Cardiopulmonary Resuscitation

System.” Accessed 24 June 2018. Available from:

http://leaderhealthcare.co/specialities/emergency-medical-

services/autopulse-cardiopulmonary-resuscitation-system-zoll/

Data on Manual CPR

Aufderheide T. “Mechanical CPR.” Accessed 24 June 2018. Available from: http://slideplayer.com/slide/13134225/. Reference contains data from:

Steill I, Brown S, Chritenson J, et al. What is the role of chest compression depth during out-of-hosptial cardiac arrest resuscitation. Crit Care Med. 2012;

40(4):119-1198. Idris A, Guffey D, Aufderheide T, et al. Relationship between chest compression rates and outcomes from cardiac arrest. Circulation. 2012;

125(24)3004-3012.

Data on Mechanical CPR• Simulated Cardiac Arrest: Quality of CPR delivered is

better with the LUCAS™ as compared to manual CPR:

• Porcine Models: Hemodynamics are improved with

LUCAS™ CPR and AutoPulse™ CPR:

Does this translate to improved patient

outcomes?

• LUCAS™

• 2014 LINC Trial (Multicenter)10

• Manual CPR (n = 1289) vs. LUCAS™ (n=1300)

• Primary: 4 Hour Survival (23.7% vs. 23.6%, p = 0.99)

• Secondary: 6 Month Survival with CPC 1 or 2 (8.5% vs. 7.6%; risk difference 0.86%; 95% CI -1.2% to 3.0%)

• Findings = No significant difference in outcomes

• 2015 PARAMEDIC Trial (Cluster RCT)11

• Manual CPR (n=2819) vs. LUCAS™ (n=1652)

• Primary: 30 Day Survival (7% vs. 6%, OR 0.86%; 95% CI 0.64-1.15)

• Findings = No significant difference in outcome

Does this translate to improved patient

outcomes?

• AutoPulse™

• 2010 ASPIRE (3 Centers, Block Randomization)12

• Manual CPR vs. AutoPulse™

• Primary: Four Hour Survival

• Secondary: Survival to Hospital Discharge

• Findings: Study Discontinued (n=1071, protocol change at one center: AutoPulse four hour survival 19% 4%)

• 2011 CIRC (Randomized, Unblinded, Sequential Trial)13

• Manual CPR (n=2132) vs. AutoPulse™ (n=2099)

• Primary: Survival to Hospital Discharge (11.0% vs. 9.4%)

• Secondary: ROSC (32.3% vs. 28.6%), 24 Hour Survival (25.0% vs. 21.8%)

• Findings: Equivalent (Adjusted odds 1.06; 95% CI 0.83-1.37)

What does the AHA say?• Piston Devices (The Thumper & LUCAS™)

• Load-Distributing Band (AutoPulse™)

American Heart Association. “Part 6: Alternative Techniques and Ancilliary Devices for Cardiopulmonary Resuscitation.” Accessed 24 June 2018. Available from:

https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-6-alternative-techniques-and-ancillary-devices-for-cardiopulmonary-resuscitation/

Are there additional findings since 2015?

• Largest Systematic Review and Meta-Analysis to Date:

• 12 Trials (9 Out-of-hospital, 3 In-hospital)

• 8 RCTs, 3 Phased Prospective Cohorts, 1 Descriptive Controlled Trial

(n=11,162) 5 LUCAS™, 4 AutoPulse™, 3 Thumper

• Findings:

• Manual chest compressions superior to mechanical chest compressions for

achieving ROSC (RR 0.71; 95% CI 0.53-0.97 in-hospital; RR 0.87; 95% CI

0.81-0.94 out-of-hospital)

• In-hospital studies demonstarting relative harm in terms of survival to hospital

discharge with mechanical compression (RR 0.54; 95% CI 0.29-0.98)

• Six Trials reporting CPC scores: CPC score of 1 or 2 at discharge: no

significant difference (RR 1.11; 95% CI 0.95-1.30).

Closing Thoughts

• So, why do we naturally like the idea of mechanical CPR?

• Allows first responders to perform other interventions

• Provides quality CPR

• Minimizes time between defibrillations

• Minimizes time off the chest

• Reduces fatigue

• Maybe not for peds…

References1. McDonald J. Systolic and mean arterial pressures during manual and mechanical CPR in humans. Ann Emerg Med.

1982;(11)6:292-295.

2. Ward K, Menegazzi J, Zelenak R, et al. A comparison of chest compressions between mechanical and manual CPR by monitoring end-tidal PCO2 during human cardiac arrest. Ann Emerg Med. 1993; 22(4):669-674.

3. Taylor G, Rubin R, Tucker M, et al. External cardiac compression. A randomized comparison of mechanical and manual techniques. JAMA. 1978; 240(7):644-646.

4. Dickson E, Verdile V, Schneider R, et al. Effectiveness of chest compressions in out-of-hospital cardiac arrest resuscitation: A pilot study. Am J Emerg Med. 1998; 16(3):289-292.

5. Jolife AB. LUCAS External Cardiac Compressor. Instructions for Use. Accessed 24 June 2018. Available from: http://www.lucas-cpr.com/doc_en/LUCAS_IFU_UK2.pdf

6. Zoll Autopulse. “Produce Manual.” Accessed 24 June 2018. Available from: https://www.zoll.com/medical-products/product-manuals?product=AutoPulse+Resuscitation+System

7. Putzer G, Braun P, Zimmermann A. LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue-a prospective, randomized, cross-over manikin study. Am J Emerg Med. 2013; 31(2):384-389.

8. Steen S, Liao Q, Pierre L, et al. Evauation of LUCAS, a new device for automatic mechanical compresson and active decompression resuscitation. Resuscitation. 2002; 55(3):285-299.

9. Halperin H, Paradis N, Ornato J, et al. Cardiopulmonary resuscitation with a novel chest compression device in a porcine model of cardiac arrest: improved hemodynamics and mechanisms. J Am Coll Cardiol. 2004; 44(11):2212-2220.

10. Rubertsson S, Lindgren E, Smekal D, et al. Mechanical chest compressions and simultaneous defibrillation vs. conventional cardiopulmonary resuscitation in out-of hospital cardiac arrest: the LINC randomized trial. JAMA. 2014; 311(1) 53-61.

11. Perkins G, Lall R, Quinn T, et al. Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised control trial. Lancet. 2015; 385(9972):947-955.

12. Paradis N, Young G, Lemeshow S, et al. Inhomogeneity and temporal effects in AutoPulse Assisted Prehospital International Resuscitation – an exception from consent trial terminated early. Am J Emerg Med. 2010; 28(4):391-398.

13. Lerner E, Persse D, Souders C, et al. Design of the Circulation Improving Resuscitation Care Trial: a new state of the art design for out-of-hospital cardiac arrest research. Resuscitation. 2011; 82(3):294-299.