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Cardiac life mechanical support in extrahospitalary donors after cardiac dead
Abstracts / Resuscitation 81S (2010) S1–S114
S63
AP114
AP116
Mechanical ventilation during CPR: Influence of intermitted positive pressure ventilation and BILEVEL ventilation on tidal volumes in a pig model
Compression velocity during CPR: Why automated CPR may perform better than manual CPR
Neuhaus C. 1 , Dietz F. 2 , Hahn O. 3 , Schwarz S. 3 , Mahling R. 3 , Wulf H. 3 , Kill C. 3
Aelen P. 1 , Paulussen I. 1 , van Berkom P. 2 , Venema A. 2 , Noordergraaf G.J. 2 , Woerlee P. 1
1 Institut
1 Biomedical
2
2
für Automatisierungstechnik und Qualitätssicherung e.V., Heidelberg, Germany Weinmann Geräte für Medizin GmbH+Co.KG, Hamburg, Germany 3 Departement of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany Objective: During CPR with secured airway, mechanical ventilation with an automated ventilator is recommend with a tidal volume of 6–7 ml/kg and a frequency of 10 breaths per minute. We investigated the mechanical ventilation in a CPR pigmodel with an automated ventilator using volume controlled intermitted positive pressure ventilation (IPPV) or pressure controlled BILEVEL positive pressure ventilation (BILEVEL). Methods: After approval by local authorities 16 pigs underwent anaesthesia with endotracheal intubation. Ventricular fibrillation was induced followed by 3 min untreated cardiac arrest. Pigs were randomized to 10 min continuous chest compressions with either IPPV (Tv 7 ml/kg, f = 10/min, 100% oxygen, no PEEP) or BILEVEL (pinsp 15–19 mbar to achieve a Tv of 7 ml/kg, f = 10/min, 100% oxygen, PEEP = 5 mbar) using an automated transport ventilator “Medumat Transport” (Weinmann GmbH, Germany). After 10 min chest compressions with mechanical ventilation ALS was performed. The airflow was measured and separated using digital high- and lowpass-filters. Tidal volumes were calculated from the first minute of CPR. Lowpass filtered signals represent mandatory ventilation, highpass the passive ventilation caused by chest compressions. Passive ventilation volumes were separately calculated during endexpiratory and endinspiratory cycle. Groups were compared using Mann–Whitney-U-Test. Results: The flow data of 14 pigs (IPPV = 7, BILEVEL = 7) could be included.
IPPV [ml] BILEVEL [ml] p
Tidal volume preset
Tidal volume mandatory
Tidal volume passive (endexp.)
Tidal volume passive (endinsp.)
273 (282/253) 255 (266/249)
245 (265/207) 250 (326/201) 0.702
30 (47/18) 65 (98/60) 0.035
65 (114/56) 95 (113/79) 0.160
Data shown as median (75/25 percentiles). Conclusions: IPPV and BILEVEL show similar mandatory volumes, that are consistent with the preset values. Passive ventilation by chest compressions are low, BILEVEL shows higher passive volumes than IPPV during expiration, probably due to the activated flowtrigger during PEEP-level. doi:10.1016/j.resuscitation.2010.09.259
Sensor Systems, Philips Research, Eindhoven, The Netherlands Dept of Anaesthesiology & Resuscitation, St. Elisabeth Hospital, Tilburg, The Netherlands
Introduction: Complete chest recoil may promote venous return to the heart, necessary for effective CPR.1 Fast, mechanical, retraction times have resulted in superior hemodynamics in animal models when compared to manual sinusoidal compression waveforms.2 In this study the compression velocity of in-hospital manual CPR is quantified and compared with the retraction velocity. Methods: Compression and retraction velocity data from 74 patients were studied. Data was obtained with a Philips HeartStart MRX QCPR pad and were corrected for mattress effects.3 For comparison, compression and retraction velocity measurements were performed with three rescuers using a Resusci Anni manikin, with a weak [60 N/cm], medium [100 N/cm], stiff [150 N/cm] and a progressive spring load. Results: Patients received compressions with a depth of 4.51 ± 0.87 cm. The compression and retraction velocities were 35 ± 8 cm/s and 26 ± 6 cm/s respectively, with the latter being a factor 1.36 ± 0.31 smaller (p < 0.001). The manikin series showed similar compression and retraction velocities for the linear loads (depth = 5.33 ± 0.77, compression velocity = 45.0 ± 15.9 cm/s, retraction velocity = 45.0 ± 15.9 cm/s) but a significant difference (p < 0.001) for the test with the progressive load (depth 5.56 ± 0.74, compression velocity = 43.3 ± 9.1, retraction velocity = 32.1 ± 5.5). Conclusion: The difference between compression and retraction velocity in manual CPR is related to the progressive distance-force relation of the human chest. With a patient resembling a non-linear load, the rescuer has to push harder in the deeper part of the compression. This diminishes the ability to switch from compression to retraction quickly, and limits the retraction velocity. These findings suggest that mechanical automated CPR devices may outperform manual CPR, as they can deliver retractions without limiting the recoil of the chest and thereby having increased time for venous return.
References 1. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005;112(Suppl. I):IV1–203. 2. Tømte Ø, et al. Discriminating the effect of accelerated compression from accelerated decompression during high-impulse CPR in a porcine model of cardiac arrest. Resuscitation 2010;81:488–92. 3. Noordergraaf GJ, et al. The impact of compliant surfaces on in-hospital chest compressions: effects of common mattresses and a backboard. Resuscitation 2009;80:546–52.
AP115 doi:10.1016/j.resuscitation.2010.09.261 Cardiac life mechanical support in extrahospitalary donors after cardiac dead Mateos-Rodriguez, Navalpotro-Pascual J.M., Pardillos-Ferrer L., Martin-Maldonado ME SUMMA112 Spain, Andres-Belmonte A Hospital 12 de Octubre Spain Introduction: The Madrid Emergency Medical Service (SUMMA112) in collaboration with Madrid’s hospitals are employed at a program of donation of patients’ organs that have suffered out-of-hospital cardiac arrest and no response of advanced life support (ALS). The study’s aim is to assessment the use of mechanical cardio pump in this program. Material and method: descriptive retrospective study based on the summary of information of the clinical records of all the cases in which the donor’s protocol has been activated in asystole (Code O) during the year 2009.It use two mechanical cardio pump: Autopulse – Zoll© and Lucas – Physio Control© . Results: A total of 52 cases. 84.6% men and 15.4% women. The average’s age was 41 years (20–61). The average’s time of arrival to place of the intervention was 11 min and 46 s. The average’s time of arrival to the hospital from the entry of the alarm call was 79 min. There were obtained 100 organs (17 liver, 1 lungs, 56 kidneys, 10 bones and 16 eye tissue), an average near 2 by patient. In 17.3% they were not valid donors. The reasons of not donation were a failure extracorporeal pump in 1 cases, family denial in 5 cases, judge negative in 2 cases and biological reason in 2 of the cases (tumoral active pathology, positive serology, etc.). Autopulse© was used in 20 cases and Lucas© in 30 cases. In two cases do not use anyone. Conclusions: The use of these devices joins perfectly the non-heart beating donors procedure. The quality improves of the RCP and facilitates the work of the emergency team. It is necessary more studies to verify if his use increases the number of donated organs. doi:10.1016/j.resuscitation.2010.09.260
AP117 A single rescuer uses a manually powered mechanical assist device for resuscitation: A simulation study Fischer H. 1 , Neuhold S. 2 , Zapletal B. 3 , Karner P. 3 , Maurer C. 3 , Stumpf D. 3 , Hochbrugger E. 4 , Koinig H. 1 , Greif R. 5 1 Department of Anaesthesia, General Intensive Care and Pain Control, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria 2 Department of Internal Medicine II, Division of Cardiology, Medical University Vienna, Vienna, Austria 3 Medical University Vienna, Vienna, Austria 4 Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria 5 Department of Anaesthesiology and Pain Therapy, University Hospital Bern and University of Bern, Bern, Switzerland
Purpose of the study: The goal of this prospective, open, randomized crossover manikin study was to compare the mechanical cardiopulmonary resuscitation (CPR) device “Animax”1 to standard single rescuer CPR. Materials and methods: With ethics committee approval and informed consent, 80 medical students trained in standard CPR and the mechanical CPR device performed basic life support according to the European Resuscitation Council (ERC) guidelines 2005 for 12-min in random order.2 Primary outcome parameter comparing efficacy and quality of chest compressions was the number of effective compressions. An effective compression was defined as a compression with the correct depth of 4–5 cm, correct compression point on the chest and sufficient decompression. This compound parameter adequately reflects effective thorax compressions generating haemodynamically efficient circulation during CPR. Furthermore, compression depth and rate, absolute hands-off time and ventilation parameters (minute volume, tidal volume and gastric inflations) were compared. Results: The use of the mechanical CPR device resulted in a higher number of effective compressions compared to standard CPR (58 ± 36% vs. 24 ± 29%, p < 0.001). With the CPR device the absolute hands-off time was lower (79 ± 40 s vs. 264 ± 57 s, p < 0.001) and minute-volume was higher (1.9 ± 0.7 L vs. 1.6 ± 0.7 L, p < 0.02). However, ventilation volumes achieved were below current ERC guidelines in both groups (370 ± 96 ml vs. 421 ± 132 ml, p < 0.001). Gastric inflation occurred only once with the CPR device compared to 115 gastric inflations during standard CPR (p < 0.001). Conclusion: Single rescuer CPR with the manually operated mechanical resuscitation device was superior to standard CPR on manikins. The CPR device delivered a higher
S63
AP114
AP116
Mechanical ventilation during CPR: Influence of intermitted positive pressure ventilation and BILEVEL ventilation on tidal volumes in a pig model
Compression velocity during CPR: Why automated CPR may perform better than manual CPR
Neuhaus C. 1 , Dietz F. 2 , Hahn O. 3 , Schwarz S. 3 , Mahling R. 3 , Wulf H. 3 , Kill C. 3
Aelen P. 1 , Paulussen I. 1 , van Berkom P. 2 , Venema A. 2 , Noordergraaf G.J. 2 , Woerlee P. 1
1 Institut
1 Biomedical
2
2
für Automatisierungstechnik und Qualitätssicherung e.V., Heidelberg, Germany Weinmann Geräte für Medizin GmbH+Co.KG, Hamburg, Germany 3 Departement of Anesthesiology and Critical Care, Philipps-University, Marburg, Germany Objective: During CPR with secured airway, mechanical ventilation with an automated ventilator is recommend with a tidal volume of 6–7 ml/kg and a frequency of 10 breaths per minute. We investigated the mechanical ventilation in a CPR pigmodel with an automated ventilator using volume controlled intermitted positive pressure ventilation (IPPV) or pressure controlled BILEVEL positive pressure ventilation (BILEVEL). Methods: After approval by local authorities 16 pigs underwent anaesthesia with endotracheal intubation. Ventricular fibrillation was induced followed by 3 min untreated cardiac arrest. Pigs were randomized to 10 min continuous chest compressions with either IPPV (Tv 7 ml/kg, f = 10/min, 100% oxygen, no PEEP) or BILEVEL (pinsp 15–19 mbar to achieve a Tv of 7 ml/kg, f = 10/min, 100% oxygen, PEEP = 5 mbar) using an automated transport ventilator “Medumat Transport” (Weinmann GmbH, Germany). After 10 min chest compressions with mechanical ventilation ALS was performed. The airflow was measured and separated using digital high- and lowpass-filters. Tidal volumes were calculated from the first minute of CPR. Lowpass filtered signals represent mandatory ventilation, highpass the passive ventilation caused by chest compressions. Passive ventilation volumes were separately calculated during endexpiratory and endinspiratory cycle. Groups were compared using Mann–Whitney-U-Test. Results: The flow data of 14 pigs (IPPV = 7, BILEVEL = 7) could be included.
IPPV [ml] BILEVEL [ml] p
Tidal volume preset
Tidal volume mandatory
Tidal volume passive (endexp.)
Tidal volume passive (endinsp.)
273 (282/253) 255 (266/249)
245 (265/207) 250 (326/201) 0.702
30 (47/18) 65 (98/60) 0.035
65 (114/56) 95 (113/79) 0.160
Data shown as median (75/25 percentiles). Conclusions: IPPV and BILEVEL show similar mandatory volumes, that are consistent with the preset values. Passive ventilation by chest compressions are low, BILEVEL shows higher passive volumes than IPPV during expiration, probably due to the activated flowtrigger during PEEP-level. doi:10.1016/j.resuscitation.2010.09.259
Sensor Systems, Philips Research, Eindhoven, The Netherlands Dept of Anaesthesiology & Resuscitation, St. Elisabeth Hospital, Tilburg, The Netherlands
Introduction: Complete chest recoil may promote venous return to the heart, necessary for effective CPR.1 Fast, mechanical, retraction times have resulted in superior hemodynamics in animal models when compared to manual sinusoidal compression waveforms.2 In this study the compression velocity of in-hospital manual CPR is quantified and compared with the retraction velocity. Methods: Compression and retraction velocity data from 74 patients were studied. Data was obtained with a Philips HeartStart MRX QCPR pad and were corrected for mattress effects.3 For comparison, compression and retraction velocity measurements were performed with three rescuers using a Resusci Anni manikin, with a weak [60 N/cm], medium [100 N/cm], stiff [150 N/cm] and a progressive spring load. Results: Patients received compressions with a depth of 4.51 ± 0.87 cm. The compression and retraction velocities were 35 ± 8 cm/s and 26 ± 6 cm/s respectively, with the latter being a factor 1.36 ± 0.31 smaller (p < 0.001). The manikin series showed similar compression and retraction velocities for the linear loads (depth = 5.33 ± 0.77, compression velocity = 45.0 ± 15.9 cm/s, retraction velocity = 45.0 ± 15.9 cm/s) but a significant difference (p < 0.001) for the test with the progressive load (depth 5.56 ± 0.74, compression velocity = 43.3 ± 9.1, retraction velocity = 32.1 ± 5.5). Conclusion: The difference between compression and retraction velocity in manual CPR is related to the progressive distance-force relation of the human chest. With a patient resembling a non-linear load, the rescuer has to push harder in the deeper part of the compression. This diminishes the ability to switch from compression to retraction quickly, and limits the retraction velocity. These findings suggest that mechanical automated CPR devices may outperform manual CPR, as they can deliver retractions without limiting the recoil of the chest and thereby having increased time for venous return.
References 1. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005;112(Suppl. I):IV1–203. 2. Tømte Ø, et al. Discriminating the effect of accelerated compression from accelerated decompression during high-impulse CPR in a porcine model of cardiac arrest. Resuscitation 2010;81:488–92. 3. Noordergraaf GJ, et al. The impact of compliant surfaces on in-hospital chest compressions: effects of common mattresses and a backboard. Resuscitation 2009;80:546–52.
AP115 doi:10.1016/j.resuscitation.2010.09.261 Cardiac life mechanical support in extrahospitalary donors after cardiac dead Mateos-Rodriguez, Navalpotro-Pascual J.M., Pardillos-Ferrer L., Martin-Maldonado ME SUMMA112 Spain, Andres-Belmonte A Hospital 12 de Octubre Spain Introduction: The Madrid Emergency Medical Service (SUMMA112) in collaboration with Madrid’s hospitals are employed at a program of donation of patients’ organs that have suffered out-of-hospital cardiac arrest and no response of advanced life support (ALS). The study’s aim is to assessment the use of mechanical cardio pump in this program. Material and method: descriptive retrospective study based on the summary of information of the clinical records of all the cases in which the donor’s protocol has been activated in asystole (Code O) during the year 2009.It use two mechanical cardio pump: Autopulse – Zoll© and Lucas – Physio Control© . Results: A total of 52 cases. 84.6% men and 15.4% women. The average’s age was 41 years (20–61). The average’s time of arrival to place of the intervention was 11 min and 46 s. The average’s time of arrival to the hospital from the entry of the alarm call was 79 min. There were obtained 100 organs (17 liver, 1 lungs, 56 kidneys, 10 bones and 16 eye tissue), an average near 2 by patient. In 17.3% they were not valid donors. The reasons of not donation were a failure extracorporeal pump in 1 cases, family denial in 5 cases, judge negative in 2 cases and biological reason in 2 of the cases (tumoral active pathology, positive serology, etc.). Autopulse© was used in 20 cases and Lucas© in 30 cases. In two cases do not use anyone. Conclusions: The use of these devices joins perfectly the non-heart beating donors procedure. The quality improves of the RCP and facilitates the work of the emergency team. It is necessary more studies to verify if his use increases the number of donated organs. doi:10.1016/j.resuscitation.2010.09.260
AP117 A single rescuer uses a manually powered mechanical assist device for resuscitation: A simulation study Fischer H. 1 , Neuhold S. 2 , Zapletal B. 3 , Karner P. 3 , Maurer C. 3 , Stumpf D. 3 , Hochbrugger E. 4 , Koinig H. 1 , Greif R. 5 1 Department of Anaesthesia, General Intensive Care and Pain Control, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria 2 Department of Internal Medicine II, Division of Cardiology, Medical University Vienna, Vienna, Austria 3 Medical University Vienna, Vienna, Austria 4 Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria 5 Department of Anaesthesiology and Pain Therapy, University Hospital Bern and University of Bern, Bern, Switzerland
Purpose of the study: The goal of this prospective, open, randomized crossover manikin study was to compare the mechanical cardiopulmonary resuscitation (CPR) device “Animax”1 to standard single rescuer CPR. Materials and methods: With ethics committee approval and informed consent, 80 medical students trained in standard CPR and the mechanical CPR device performed basic life support according to the European Resuscitation Council (ERC) guidelines 2005 for 12-min in random order.2 Primary outcome parameter comparing efficacy and quality of chest compressions was the number of effective compressions. An effective compression was defined as a compression with the correct depth of 4–5 cm, correct compression point on the chest and sufficient decompression. This compound parameter adequately reflects effective thorax compressions generating haemodynamically efficient circulation during CPR. Furthermore, compression depth and rate, absolute hands-off time and ventilation parameters (minute volume, tidal volume and gastric inflations) were compared. Results: The use of the mechanical CPR device resulted in a higher number of effective compressions compared to standard CPR (58 ± 36% vs. 24 ± 29%, p < 0.001). With the CPR device the absolute hands-off time was lower (79 ± 40 s vs. 264 ± 57 s, p < 0.001) and minute-volume was higher (1.9 ± 0.7 L vs. 1.6 ± 0.7 L, p < 0.02). However, ventilation volumes achieved were below current ERC guidelines in both groups (370 ± 96 ml vs. 421 ± 132 ml, p < 0.001). Gastric inflation occurred only once with the CPR device compared to 115 gastric inflations during standard CPR (p < 0.001). Conclusion: Single rescuer CPR with the manually operated mechanical resuscitation device was superior to standard CPR on manikins. The CPR device delivered a higher