Elsevier

Resuscitation

Volume 34, Issue 3, June 1997, Pages 235-242
Resuscitation

Quality of mechanical, manual standard and active compression–decompression CPR on the arrest site and during transport in a manikin model

https://doi.org/10.1016/S0300-9572(96)01087-8Get rights and content

Abstract

The quality of mechanical CPR (M-CPR) was compared with manual standard CPR (S-CPR) and active compression–decompression CPR (ACD-CPR) performed by paramedics on the site of a cardiac arrest and during manual and ambulance transport. Each technique was performed 12 times on manikins using teams from a group of 12 paramedic students with good clinical CPR experience using a random cross-over design. Except for some lost ventilations the CPR effort using the mechanical device adhered to the European Resuscitation Council guidelines, with an added time requirement of median 40 s for attaching the device compared with manual standard CPR. Throughout the study, in comparison with mechanical CPR the quality of CPR with either manual method was significantly worse. In particular, there were considerable individual variations during stretcher transport. With S-CPR and ACD-CPR the median compression times were 38 and 31%, significantly lower than the recommended 50%, and 46–98% of the decompression efforts with ACD-CPR were too weak, particularly during transport on the stairs. With both manual methods, there were no significant differences in the CPR effort between the site of the arrest and the ambulance transport. However, compression rates were reduced and became more erratic during stretcher transport to the ambulance. When walking horizontally, a median of 19% of S-CPR compressions and 84% of ACD-CPR compressions were to weak. On the stairs, 68% of S-CPR compressions and 100% of ACD-CPR compressions were too weak. In conclusion, when evaluated on a manikin, in comparison with manual standard and ACD-CPR, mechanical CPR adhered more closely to ERC guidelines. This was particularly true when performing CPR during transport on a stretcher.

Introduction

The outcome after cardiac arrest is influenced by the quality of the cardiopulmonary resuscitation (CPR) including the thoracic compressions and ventilations 1, 2. Some patients are transported to hospital with ongoing CPR, with a survival close to zero 3, 4. It has previously been reported that the quality of the thoracic compressions was significantly better during ambulance transport when a mechanical device was used instead of standard manual compressions 5, 6.

Active compression–decompression CPR (ACD-CPR) improves the hemodynamics compared with standard CPR in animal studies 7, 8, 9, but published prehospital clinical studies of ACD-CPR have not shown an improvement in the rate of return of spontaneous circulation (ROSC) or survival compared with standard CPR (S-CPR) 10, 11, 12.

We wondered if this could be due to difficulties in adhering to the recommended technique for ACD-CPR with the Ambu Cardiopump [13]in the clinical setting. We wondered also how well paramedics managed to perform ACD-CPR during ambulance transport. If a patient is transported to hospital with ongoing CPR, it must also be performed from the site of the cardiac arrest to the ambulance, most often from inside a house and frequently down stairs. The quality of CPR during manual transport has not previously been reported.

We have therefore compared mechanical standard CPR (M-CPR) with the manual methods, S-CPR and ACD-CPR, in a prehospital cardiac arrest situation on a manikin model, transporting the `patient' from an apartment to the hospital. The aims of the study were to compare the quality of the CPR efforts, and possible differences in the time required for a standardized cardiac arrest scenario when M-CPR is introduced at the scene of the arrest.

Section snippets

Preparation

S-CPR, ACD-CPR and M-CPR were compared in a randomized, cross-over, out-of-hospital study on a manikin (Ambu-Man CPR Training Module with ACD, Ambu International, Glostrup, Denmark). Each CPR method was studied 12 times, using 12 paramedic students, close to finishing their 2 years of training in the Oslo Emergency Medical Service System (EMS), as study subjects. All of them had extensive training in manual S-CPR, and the Megacode Testing System (Ambu International, Glostrup, Denmark). The

Results

There were significant differences in the CPR performance with the three methods in all the measured time periods. All compressions with the mechanical CPR device were within the preset standards both for depth and frequency throughout the study, except for the initial few seconds when the machine required a few strokes to build up to the correct depth (Table 2 and Table 3). The machine stopped altogether four times during the ambulance transports, probably due to a problem with the hydraulic

Discussion

The quality of the basic CPR manouvers (compressions and ventilations) have been shown to influence the outcome of cardiac arrests 1, 2. The circulatory effects are influenced by the frequency 15, 16, 17, depth 18, 19and the duration of the compressions 15, 20, 21, 22, and even with optimal standard CPR, the coronary perfusion pressure (CPP) is only 20–30% of normal 7, 9. It was not the purpose of this study to evaluate the ideal frequency, depth and duration of the compressions, but whether

Acknowledgements

This study was supported by the Norwegian Air Ambulance and the Laerdal Foundation for acute medicine. The authors would like to thank the 17 paramedic students and especially their teacher Jon Thowsen at the Oslo EMS, and the head of the Oslo Emergency and Dispatch Center, MD Jan Erik Nilsen, who were invaluable in performing this study. We would also like to thank Snøgg-Ambu Norway for providing us with the Mega Code Trainer, and Ambu International, Glostrup, Denmark, for providing us with

References (28)

  • Wik L, Steen PA, Bircher NG. Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital...
  • Van Hoeyweghen RJ, Bossaert LL, Mullie A, Calle P, Martens P, Buylaert WA, Delooz H. Belgian cerebral resuscitation...
  • Bonnin MJ, Pepe PE, Kimball KT, Clark PS. Distinct criteria for termination of resuscitation in the out-of-hospital...
  • Herlitz J, Bång A, Ekstrøm L, Holmberg S. Outcome for patients with out-of-hospital cardiac arrest for whom...
  • Stapleton ER. Comparing CPR during ambulance transport. JEMS 1991, Sept:...
  • Roberts BG. Machine vs. manual cardiopulmonary resuscitation in moving vehicles. The EMT Journal 1979; 3:...
  • Wik L, Naess PA, Ilebekk A, Nicolaysen G, Steen PA. Effects of various degrees of compression and active decompression...
  • Chang MW, Coffeen P, Lurie KG, Schultz J, Bache RJ, White CW. Active compression-decompression CPR improves vital organ...
  • Lindner KH, Pfenninger EG, Schurman W, Lurie KG, Schurman W, Lindner IM, Ahnefeld FW. Effects of...
  • Schwab TM, Callaham ML, Madsen CD, Utecht TA. A randomized clinical trial of active compression-decompression CPR vs...
  • Stiell IG, Hebert PC, Wells GA, Weitzman BN, et al. The Ontario trial of active compression-decompression...
  • Luiz T, Ellinger K, Denz C. Active compression-decompression cardiopulmonary resuscitation does not improve survival in...
  • Wik L, Mauer D, Robertson C. The first European pre-hospital active compression-decompression (ACD) cardiopulmonary...
  • Guidelines for basic life support, European Resuscitation Council. Resuscitation 1992; 24:...
  • Cited by (104)

    View all citing articles on Scopus
    View full text