For example, in an analysis of 9136 OHCA patients, only 45% received the recommended guideline chest compression depth. Specific barriers include provider fatigue, physical effort to overcome stiffness of the patient’s thoracic cage, and compressible underlying surfaces, such as mattresses, which can lead to shallow chest compressions. ĭespite consistent observational data showing the association between CPR quality and patient outcome, the delivery of high-quality manual chest compressions is challenging in both the out-of-hospital and in-hospital settings. International guidelines highlight the importance of high-quality chest compressions, which are defined as compressions at a depth of 5–6 cm and a rate of 100–120 per minute, allowing full chest recoil between compressions, and minimisation of interruptions. The purpose of this review is to provide an update on mechanical device use for both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), an overview on device use in special circumstances, and guidance on deployment in the clinical setting. The key theoretical benefit to the use of such devices is their ability to consistently deliver high-quality chest compressions, which has been associated with improved intra-arrest haemodynamic profiles. The device consistently delivers compressions at a rate of 102 per minute and a depth of 5.3 cm in patients with a sternal height greater than 18.5 cm. It consists of two parts (a backplate and the piston mechanism), which link together to encircle the patient. The LUCAS (Physio-Control Inc./Jolife AB, Lund, Sweden) is an example of a piston device, which also incorporates a mechanism for active chest recoil. The Autopulse (Zoll Medical, Chelmsford, MA, USA) is a load distributing band device, which consists of a large backplate that is positioned behind the patient and a band that encircles the patient’s chest to deliver compressions at a rate of 80 per minute and a depth of 20% of the anterior-posterior chest height. A number of devices are currently marketed, but devices can be broadly categorised as load distributing band or piston devices, based on the mechanism that is used to deliver compressions. Mechanical chest compression devices deliver high-quality external chest compressions, in place of a human rescuer. Despite its importance, the sustained delivery of high-quality cardiopulmonary resuscitation (CPR) is infrequently achieved in clinical practice. High-quality chest compressions are a critical component in the cardiac arrest chain of survival. In summary, mechanical CPR devices may provide a useful adjunct to standard treatment in specific situations, but current evidence does not support their routine use. It is recommended that use of mechanical devices should occur only in systems where quality assurance mechanisms are in place to monitor and manage pauses associated with deployment. The deployment process requires interruptions in chest compression, which may be harmful if the pause is prolonged. The precise time point during a cardiac arrest at which to deploy a mechanical device is uncertain, particularly in patients presenting in a shockable rhythm. Examples of such situations include ambulance transportation, primary percutaneous coronary intervention, as a bridge to extracorporeal CPR and to facilitate uncontrolled organ donation after circulatory death. In situations where high-quality manual chest compressions cannot be safely delivered, the use of a mechanical device may be a reasonable clinical approach. The limited data on use during in-hospital cardiac arrest provides preliminary data supporting use of mechanical devices, but this needs to be robustly tested in randomised controlled trials. However, large randomised controlled trials of the routine use of mechanical devices in the out-of-hospital setting have found no evidence of improved patient outcome in patients treated with mechanical CPR, compared with manual CPR. Mechanical CPR devices provide an automated way to deliver high-quality CPR. However, delivery of effective chest compressions is often inconsistent, subject to fatigue and practically challenging. In cardiac arrest, high quality cardiopulmonary resuscitation (CPR) is a key determinant of patient survival.
0 Comments
Leave a Reply. |