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