Friday, March 24, 2017

Mechanical CPR (out-of-hospital)

R.E.B.E.L.EM - March 23, 2017 - By Salim Rezaie
Ref. Buckler DG et al. Association of mechanical cardiopulmonary resuscitation device use with cardiac arrest outcomes: a population-based study using the CARES registry (Cardiac Arrest Registry to Enhance Survival). Circulation 2016; 134: 2131-33. PMID: 27994028
"Background: The two most important things that we can do in cardiac arrest to improve survival and neurologically intact outcomes is high quality CPR, with limited interruptions and early defibrillation. In the case of the former, the 2015 AHA/ACC CPR updatesrecommended a compression rate of 100 -120/min, a depth of 2 – 2.4in, allowing full recoil, and minimizing pauses. This is a lot to remember during a stressful code situation and one way many providers are offloading themselves cognitively is by the use of mechancical CPR (mCPR) devices. In theory these devices compress at a fixed rate, and depth, with the added benefit that the machine simply does not tire out. Additionally, use of this device allows another provider to be available for other procedures and interventions. A recent systematic review and meta-analysis in looked at five randomized clinical trials with over 10,000 patients with out-of-hospital cardiac arrest (OHCA) (Gates 2015). They concluded that there was no difference in ROSC, survival or survival with good neurological outcomes with the use of these devices compared to manual CPR. It is important to state that none of these studies showed increased harm either. A new paper just published in Circulation however, argues that mCPR during OHCA was associated with lower neurologically intact survival.
Author Conclusion: “In conclusion, the use of mCPR during out-of-hospital cardiac arrest was associated with lower neurologically favorable survival within emergency medical services agencies participating in CARES. Although the use of mCPR devices increased during the study period, deployment rates remained highly variable, and the majority of agencies did not use them. Further research is required to identify circumstances in which mCPR may benefit patients with out-of hospital cardiac arrest; however our data indicate that mCPR for routine cardiac arrest care was associated with worse outcomes.”