Another mechanical CPR study abstract

medicsb

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My personal thoughts on mechanical CPR is that its best utility is freeing hands for other tasks or for return to usual duty of personnel who would other wise be doing compressions. Its best use is NOT for improving survival.


Prehosp Emerg Care. 2018 Jan 18:1-7. doi: 10.1080/10903127.2017.1394405. [Epub ahead of print]
No Benefit in Neurologic Outcomes of Survivors of Out-of-Hospital Cardiac Arrest with Mechanical Compression Device.
Newberry R, Redman T, Ross E, Ely R, Saidler C, Arana A, Wampler D, Miramontes D.
Abstract
INTRODUCTION:
Out-of-hospital cardiac arrest (OHCA) is a major cause of death and morbidity in the United States. Quality cardiopulmonary resuscitation (CPR) has proven to be a key factor in improving survival. The aim of our study was to investigate the outcomes of OHCA when mechanical CPR (LUCAS 2 Chest Compression System™) was utilized compared to conventional CPR. Although controlled trials have not demonstrated a survival benefit to the routine use of mechanical CPR devices, there continues to be an interest for their use in OHCA.

METHODS:
We conducted a retrospective observational study of OHCA comparing the outcomes of mechanical and manual chest compressions in a fire department based EMS system serving a population of 1.4 million residents. Mechanical CPR devices were geographically distributed on 11 of 33 paramedic ambulances. Data were collected over a 36-month period and outcomes were dichotomized based on utilization of mechanical CPR. The primary outcome measure was survival to hospital discharge with a cerebral performance category (CPC) score of 1 or 2.

RESULTS:
This series had 3,469 OHCA reports, of which 2,999 had outcome data and met the inclusion criteria. Of these 2,236 received only manual CPR and 763 utilized a mechanical CPR device during the resuscitation. Return of spontaneous circulation (ROSC) was attained in 44% (334/763) of the mechanical CPR resuscitations and in 46% (1,020/2,236) of the standard manual CPR resuscitations (p = 0.32). Survival to hospital discharge was observed in 7% (52/763) of the mechanical CPR resuscitations and 9% (191/2,236) of the manual CPR group (p = 0.13). Discharge with a CPC score of 1 or 2 was observed in 4% (29/763) of the mechanical CPR resuscitation group and 6% (129/2,236) of the manual CPR group (p = 0.036).

CONCLUSIONS:
In our study, use of the mechanical CPR device was associated with a poor neurologic outcome at hospital discharge. However, this difference was no longer evident after logistic regression adjusting for confounding variables. Resuscitation management following institution of mechanical CPR, specifically medication and airway management, may account for the poor outcome reported. Further investigation of resuscitation management when a mechanical CPR device is utilized is necessary to optimize survival benefit.
 

Old Tracker

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I'd like to know how long the time frame was between arrival to the Pt, putting on the device, and how long the transports were. How long after the initial incident until arrival at the ER in other words.

80 to 90 minute trip to the ER, after loading Pt is usually not good for a long term good outcome. Just sayin' from my limited experience with MIs.
 

Airlinepilotmedic

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This study was based off the Lucas device and not the autopulse that does circumferential compressions. There is a large difference between how the two devices perform.
 

MonkeyArrow

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Resuscitation management following institution of mechanical CPR, specifically medication and airway management, may account for the poor outcome reported.
I'd like to know what specifically this sentence means and whether they adjusted for this in their regression model.
 

VFlutter

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So they strictly compared Mechanical vs Manual CPR? I would like to see the break down of Witnessed vs Un-witnessed and presenting rhythm of each group. Really hard to draw a conclusion without accounting for those variables.
 

StCEMT

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So they strictly compared Mechanical vs Manual CPR? I would like to see the break down of Witnessed vs Un-witnessed and presenting rhythm of each group. Really hard to draw a conclusion without accounting for those variables.
Agreed. Even anecdotally, there is a huge difference in results between witnessed and unwitnessed.
 

FiremanMike

EMS Coordinator
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With 3000 patients and a survival rate of 7-9%, I have to assume this study included ALL arrests and not just utstein arrests. I respect this, as I think excluding all but the most viable arrest patients is silly.

That said, I am curious like the poster above if this study just looked at the Lucas or included the autopulse as well..
 

zzyzx

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reaper

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"My personal thoughts on mechanical CPR is that its best utility is freeing hands for other tasks or for return to usual duty of personnel who would other wise be doing compressions. Its best use is NOT for improving survival. "

Agreed.
Standing up in the back of an ambulance doing CPR. Having to coach people on doing better compressions. Having to worry about CPR interruptions. All of that could be eliminated with mechanical CPR. I wish we used it where I work.
This is not the first study with these results. Main thing is easy. Work on scene, Train personnel on compressions and minimize interruptions. Simple, smooth codes and better out comes.
 

RocketMedic

Californian, Lost in Texas
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Not to mention that many patients are automatically excluded from mechanical CPR based on size.
 

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