Mechanical devices for cardiac massage: must-have or luxury?
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Transcript of Mechanical devices for cardiac massage: must-have or luxury?
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Mechanical devices for cardiac massage:
must-have or luxury? Giuseppe Biondi-Zoccai, MD
Sapienza University of Rome, [email protected]
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Learning goals
• Why do we need mechanical devices for cardiac massage
• Which devices are available• What are their pros• What are their cons• Evidence• Case study
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Learning goals
• Why do we need mechanical devices for cardiac massage
• Which devices are available• What are their pros• What are their cons• Evidence• Case study
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The quality of manual chest compression is variable, and when low is deadly
Abella et al, Circulation 2005
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Manual chest compression may never be done adequately in selected settings
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Learning goals
• Why do we need mechanical devices for cardiac massage
• Which devices are available• What are their pros• What are their cons• Evidence• Case study
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Thumper (i.e. Life-Stat)
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Vest CPR
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AutoPulse
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AutoPulse
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LUCAS
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LUCAS
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CardioPump ACD-CPR
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CardioPump ACD-CPR
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Learning goals
• Why do we need mechanical devices for cardiac massage
• Which devices are available• What are their pros• What are their cons• Evidence• Case study
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Obvious advantages
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Reliability and force
Steen et al, Resuscitation 2002
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Reliability and force
Cardiac arrest
Manual compression
LUCAS
Agostoni et al, Int J Cardiol 2008
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Compression and decompression
Steen et al, Resuscitation 2002
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Learning goals
• Why do we need mechanical devices for cardiac massage
• Which devices are available• What are their pros• What are their cons• Evidence• Case study
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Trauma
Larsen et al, Resuscitation 2007
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Coronary pressure may be too low
Larsen et al, Resuscitation 2010
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Defibrillation may be delayed
Putzer et al, Am J Emerg Med 2013
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Learning goals
• Why do we need mechanical devices for cardiac massage
• Which devices are available• What are their pros• What are their cons• Evidence• Case study
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Non-randomized trial
Axelsson et al, Resuscitation 2006
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RCT of AutoPulse
Hallstrom et al, JAMA 2006
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RCT of CardioPump ACD-CPR and ITD
Aufderheide et al, Lancet 2011
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Learning goals
• Why do we need mechanical devices for cardiac massage
• Which devices are available• What are their pros• What are their cons• Evidence• Case study
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Case studyAge: 40 yearsGender: maleComorbidities: type 1 diabetes mellitusDiagnosis: acute myocardial infarction Prehospital events/management: VF treated with DC shock, followed by PEA; manual chest compression, repeat IV adrenaline boluses, tracheal intubation, mechanical ventilationHospital events/management: systemic thrombolysis with alteplase attempted without success; LUCAS deployment and transfer to the cath lab
Biondi-Zoccai et al, HSR Proc Intensive Care Cardiovasc Anesth 2011
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Baseline coronary angiography
Biondi-Zoccai et al, HSR Proc Intensive Care Cardiovasc Anesth 2011
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Predilation on left main-circumflex
Biondi-Zoccai et al, HSR Proc Intensive Care Cardiovasc Anesth 2011
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Left main-anterior descending stenting
Biondi-Zoccai et al, HSR Proc Intensive Care Cardiovasc Anesth 2011
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Coronary angiography after stenting
Biondi-Zoccai et al, HSR Proc Intensive Care Cardiovasc Anesth 2011
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Take home message
• Despite ongoing research for several decades, manual chest compression remains the gold standard means to perform cardiac massage.
• Mechanical devices have several advantages in comparison to manual chest compression.
• High-quality evidence is still lacking and a selected use of these devices is the safest approach until ongoing trials (e.g. CIRC, LINC and PARAMEDIC) are complete.
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Many thanks for your attention
For these slides and further ones on similar topics feel free to visit:
www.metcardio.org/slides.html
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