Mechanical Compressions versus Manual Compressions in Cardiac Arrest

Mechanical Compressions versus Manual Compressions in Cardiac Arrest Larissa Fritts School of PA Studies | Pacific University | 222 SE 8 th Ave | Hillsboro | 97123 | Oregon BACKGROUND Summary of Findings More than 350000 people suffer an out of hospital cardiac arrest every year. 1 Even when medical providers have adequate training it can be difficult to carry out an effective resuscitation due to suboptimal CPR, multiple interventions needing to be done simultaneously, and many other less than ideal conditions. What if there was an alternative for compressions during emergency situations that could provide uninterrupted quality CPR and improve provider safety? LUCAS was developed in Sweden in 2002 to provide just that. 2 Many studies have attempted to evaluate the use of mechanical compressions in a variety of situations. Regardless of whether mechanical compressions improve survival, more and more evidence is coming forward suggesting that there are situations in which mechanical compressions may play an important role. RESULTS METHODS An exhaustive search of available medical literature including MEDLINE-Ovid, Pub Med, Web of Science, and CINAHL was performed using keywords: “mechanical compressions/LUCAS”, “manual compressions/CPR”, and “prehospital/emergency medical services/out of hospital cardiac arrest”. These were screened with eligibility criteria and resulting studies were then assessed for quality with GRADE. Two studies 3, 4 were related to the effect of mechanical compressions on survival outcomes during an out of hospital cardiac arrest. Two studies 3, 4 were included in this systematic review, meeting all inclusion criteria. The LINC study 3 is a RCT that looked at 4471 patients who experienced an OHCA. It found that mechanical compressions provide no benefit over manual compressions when looking at survival rates or neurological status. The PARAMEDIC study 4 another RCT looked at survival rates of mechanical vs. manual compressions following an OHCA. Survival rates did not significantly differ between the groups, but favorable neurological outcomes were lower in the LUCAS group when compared to manual compressions. REFERENCES 1. 2. 3. Mechanical compressions using LUCAS 4. 5. Manual compressions during the same resuscitation Acknowledgements: Thank you to all my friends and family who helped get me to this point. I am so lucky to have your support and encouragement! 6. Cardiac arrest statistics. www. heart. org. Accessed September/27, 2015. Lucas chest compression system. http: //www. lucascpr. com/en/lucas_cpr/product_literature. Accessed september/29, 2015. Rubertsson S, Lindgren E, Smekal D, et al. Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: The LINC randomized trial. JAMA. 2014; 311(1): 53 -61. Perkins GD, Lall R, Quinn T, et al. Mechanical versus manual chest compression for out-ofhospital cardiac arrest (PARAMEDIC): A pragmatic, cluster randomised controlled trial. Lancet. 2015; 385(9972): 947 -955. Accessed 20150318. doi: http: //dx. doi. org/10. 1016/S 01406736(14)61886 -9. Putzer G, Braun P, Zimmermann A, et al. LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue-a prospective, randomized, crossover manikin study. Am J Emerg Med. 2013; 31(2): 384 -389. http: //ovidsp. ovid. com/ovidweb. cgi? T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=2 3000324. Accessed 20130214. doi: http: //dx. doi. org/10. 1016/j. ajem. 2012. 07. 018. Forti A, Zilio G, Zanatta P, et al. Full recovery after prolonged cardiac arrest and resuscitation with mechanical chest compression device during helicopter transportation and percutaneous coronary intervention. J Emerg Med. 2014; 47(6): 632 -634. http: //ovidsp. ovid. com/ovidweb. cgi? T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=2 5300208. Accessed 20141201. doi: http: //dx. doi. org/10. 1016/j. jemermed. 2014. 066. DISCUSSION The body of evidence reviewed had a high GRADE suggesting that there is no evident benefit of mechanical compressions over manual compressions in surival rates. However, the LINC 3 and PARAMEDIC 4 studies demonstrate that CPR using automated compressions can be done with minimal complications and ultimately there are instances where the automated compression device can be better for patients and providers. Multiple studies have looked at the technical superiority of mechanical compressions over that of manual compressions to examine scenarios which may benefit from automated devices. LUCAS was used during helicopter rescue scenarios; compressions were more frequently correct before, during, and after flight. 5 Automated devices may allow for prolonged resuscitation during transport while reducing risk to the medical providers and improving survival rates at the same time. Due to the extreme difficulty of performing effective chest compressions during PCI, mechanical compressions may play an important role of maintaining perfusion until the procedure can be finished. 6 Additional research needs to be conducted to better examine the algorithms implemented vs. the method of compression used as it is still unclear which makes the most impact on survival rate. Current research will hopefully shed light on circumstances in which there is proven benefit in utilizing mechanical compressions and can therefore help guide future management of cardiac arrest. Until that research is completed everyone can rest assured that manual compressions are an efficient and necessary intervention during a pre hospital cardiac arrest with positive effects on survival outcome. CONCLUSION Reassuring is the result that manual compressions are equally effective compared to mechanical compressions in relation to survival rates after an OHCA, unfortunately that also means mechanical compressions do not provide significant improvement in survival rates during cardiac arrest resuscitation. Mechanical compressions have been shown to provide consistent, effective, more technically sound compressions than manual CPR which may provide a significant advantage during specific scenarios: difficult transport, prolonged resuscitation, and during PCI. 5, 6 Further research in these unique situations needs to be done to establish if the variations in outcomes are due to type of compression or the overarching algorithm implemented. This additional research can direct facilities in determining if implementing the use of an automated compression device is in their best interest for their providers and their patients. CONTACT INFORMATION Larissa Fritts Physician Assistant Student T: 719 -588 -3400 E: galp 0856@pacificu. edu