Mechanical Cardiopulmonary Resuscitation

Lund University cardiac arrest System (LUCAS)

The latest AHA 2010 guidelines on CPR has changed it’s sequence from ABC to CAB and stressed on the importance of effective chest compression. While there are still many debates exist in this sequence as the ATLS protocol and Neonatal Resus Protocol still maintaining it’s ABC sequences, the message is clear that chest compression should be done as effective as possible in order for the patient to achieve Return of Spontaneous Circulation. (ROSC)

The AHA guidelines defines the High Quality and Effective CPR through the criteria of 1) Rate is at least 100 compression per minute, 2) Depth of compression is 2 inches/5 cm in adult and 1 ½ inches in infants, 3) Minimal interruption as possible and it should be less than 10 seconds, 4) Avoiding excessive hyperventilation, and 5) Allow the chest wall to fully recoil in between compression.

In order to achieve that, the guidelines suggest that the rescuer taking turn every two minutes in performing CPR in order to minimize fatigue, do not stop the CPR while attaching the AED machine until the rhythm is being analyzed and less than 10 seconds should be use in checking the pulse.

However, we as a human still bound to the weakness and inconsistencies despite of many measures that we take. Besides, other issue also arise like should we do the CPR in ambulance? Will it still be effective, remain as a high quality CPR and the most importantly, will it guarantee the safeness of the healthcare provider?  

Autopulse - load distributing band (LDB) CPR

While it is still relatively new in Malaysia, the usage of the mechanical CPR devices has actually being practices around the world for a long time. The history itself begin from research in 1960’s and continues until now. 

From my personal opinion, this invention is indeed a genius art despite of conflicting study result regarding the usage of this device. For me, this device is a practical practice especially in continuation of CPR in the ambulance or when the CPR providers are getting tired.

The Conchrane Review 2011 found that there is insufficient evidence from human RCT's to conclude that mechanical chest compression is associated with benefit or harm. Ong et al (2012) in their review of 88 articles identify 10 studies that meet their inclusion criteria and finally draw a conclusion that that there are insufficient evidence to support or refute the use of mechanical CPR devices in setting of out hospital cardiac arrest and during ambulance transport. They further add that there is some low quality evidence suggesting that mechanical CPR  can improve consistency and reduce interruptions in chest compression. However, there is no evidence that mechanical CPR devices improve survival, to the contrary they may worsen neurological outcome.

Furthermore, the cost of implementing this procedure is very expensive compared to the traditional CPR which is of course free of charge. Therefore, i think that the usage of this device should be justified in context of physician preferences for now until there is a well establish study on this aspect.

Reference

Steven C Brooks, Blair L Bigham, Laurie J Morrison, "Mechanical versus Manual Chest Compression for Cardiac Arrest", Conchrane Database, 2011

Ong et al, "Mechanical CPR Devices Compared to Manual CPR During Out-of-hospital Cardiac Arrest and Ambulance Transport: A Systemic Review", Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:39.