- Email: [email protected]
Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest
S62
Abstracts / Resuscitation 81S (2010) S1–S114
AP110
AP112
Injuries caused by the autopulse and LUCAS II resuscitation systems compared to manual chest compressions
Less invasive cardiopulmonary bypass for rapid and safe method of therapeutic hypothermia in Japan
Truhlar A. 1,2 , Hejna P. 3 , Zabka L. 1 , Zatopkova L. 3 , Cerny V. 2,4
Kaji A., Morimoto K., Hosomi S., Suehiro S., Ishikawa J., Fuke A., Arimoto H., Miyaichi T., Kan M., Rinka H.
1 Hradec
Kralove Region Emergency Medical Service, Hradec Kralove, Czech Republic 2 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic 3 Institute of Legal Medicine, Charles University Prague, Faculty of Medicine Hradec Kralove, Czech Republic 4 Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada Introduction: Mechanical chest compression devices provide an alternative to manual CPR but may cause injuries.1,2 Our study aimed to compare injuries caused by the AutoPulse (Zoll, USA), LUCAS II (Jolife, Sweden), and manual CPR in both survivors and nonsurvivors of out-of-hospital cardiac arrest (OHCA). Methods: This was a prospective study including nontraumatic OHCAs from January 1st to April 30th, 2010. Two EMS units were equipped with two different mechanical devices. The AutoPulse (A-CPR) was located in a helicopter dispatched predominantly into rural areas, while the LUCAS II (L-CPR) was used by a physician response unit in the city. Manual CPR (M-CPR) was performed if an ambulance with no device was dispatched. The survivors underwent physical examination and a thoracic X-ray, nonsurvivors were autopsied. Data were analyzed using Fisher’s exact test. Results: CPR was attempted in thirty patients: A-CPR 8, L-CPR 11, and M-CPR 11. Injuries were observed in 7/8 (87.5%) in A-CPR, 8/11 (72.7%) in L-CPR, and 3/11 (27.3%) in M-CPR group (P = 0.02). Sternal fractures were present in 3/8, 4/11, and 1/11 (P = 0.33), multiple rib fractures (≥3) in 4/8, 6/11, and 2/11 (P = 0.25), and mediastinal haematomas in 5/8, 2/11, and 0/11 patients (P = 0.003). Pericardial effusions (2 pts) and adventitial aortic haematomas (4 pts) were observed in A-CPR group only (P = 0.06 and 0.002). There was found one cardiac tamponade considered to be primary cause of OHCA. Neither pulmonary nor abdominal injuries were observed. There were 1/8 (12.5%), 1/11 (9.1%), and 4/11 (36.4%) patients discharged from hospital [CPC 1–2] (P = 0.33). Preliminary results of this study are limited by its size and prior BLS (90.0%) whose complications are difficult to separate from device associated injuries. Conclusion: Use of mechanical chest compression devices was associated with increased incidence of injuries compared to manual CPR but surprisingly also with a trend to worse survival. References 1. Perkins GD, Brace S, Gates S. Mechanical chest-compression devices: current and future roles. Curr Opin Crit Care 2010;16:203–10. 2. de Rooij PP, Wiendels DR, Snellen JP. Fatal complication secondary to mechanical chest compression device. Resuscitation 2009;80:1214–5. doi:10.1016/j.resuscitation.2010.09.255 AP111 Implementation of a mechanical compression device as standard equipment in a large, urban ambulance system Satterlee P.A. 1 , Boland L.L. 2 , Johnson P. 2 , Hagstrom S.G. 1 , Page D.I. 1 , Lick C.J. 1 1 Allina 2
Medical Transportation, St. Paul, Minnesota, USA Center for Healthcare Innovation, Allina Hospitals & Clinics, Minneapolis, Minnesota, USA
Purpose: Since 2005, emphasis has been placed on delivering consistent, uninterrupted chest compressions during treatment of cardiac arrest. Research has shown that chest compressions performed manually are often slower than recommended and compromised by frequent interruptions, and that mechanical compression devices offer a superior alternative. We implemented a mechanical compression device (LUCASTM , Jolife) as standard equipment on every advanced life support (ALS) ambulance in our service, to be used in every instance where resuscitation was attempted. Setting and methods: Allina Medical Transportation provides advanced and basic life support services to 1,000,000 people in 80 communities in and around Minneapolis, MN, employing nearly 300 paramedics and emergency medical technicians. After pilot testing 10 mechanical compression devices in first responder vehicles, receiving facilities, and ALS ambulances, we decided to expand access by equipping every ALS ambulance with the device. We purchased 30 units, trained all ambulance personnel within 3 months, established an operational plan for maintenance, and initiated data collection on use. Results: During a 2-year period, the mechanical compression device was used on approximately 400 patients, and 50 instances where patients were incompatible with the device were documented. We found use of the device to be simple and effective, and few problems were encountered by providers when using the device. Overall, staff and first responders are highly satisfied with the device, despite initially experiencing some minor operational challenges with storing and powering the machine. Conclusions: Optimal chest compressions are essential for effective resuscitation of victims of cardiac arrest. Broad application of an air-powered mechanical compression device across a large, urban ambulance service is feasible and likely improves the quality of chest compressions. The device we have selected is easy to learn, simple to use, and has become the standard of care for cardiac arrest victims in the communities we serve. doi:10.1016/j.resuscitation.2010.09.256
Emergency and Critical Care Medical Centre, Osaka City General Hospital, Japan Purpose of study: Therapeutic hypothermia results good neurological outcome after out-of-hospital cardiac arrest. But during introduction and maintenance stage around the proper temperature, we often encountered with many difficulties (shivering, poor peripheral circulation, arrhythmias and other life-threatening complications). So we introduce Less Invasive Cardiopulmonary Bypass (LICH) after Recovery Of Spontaneous Contraction (ROSC) patients. Conservative surface cooling methods and LICH methods are retrospectively evaluated in the point of view of easiness, complications and disadvantages during both introduction and maintenance periods. Materials and methods: For 36 months (2007–2009), 23 cases were introduced by the conservative surface cooling methods (group C). 17 cases were actively introduced by LICH at Emergency Room (group L). Group L had been maintained with using LICH during ICU for 24–48 h. Group C was maintained with the conservative cooling methods. Therapeutic hypothermia period were continued for 24–48 h in both groups. Neurological outcome, complications and speed for the proper body temperature were evaluated retrospectively. Results: Both groups had no difference of neurological outcome. Group L have obviously quickly achieved the proper body temperature. Catecholamimes were less used in group L. Conclusion: LICH method using child bypass circuit system is preferable for introduction and maintenance of therapeutic hypothermia therapy for ROSC patients. The reasons are: 1. Rapidly achieved to hypothermia 2. Easy to control the body temperature 3. Easy to encourage scirculation without any catecholamine supports doi:10.1016/j.resuscitation.2010.09.257 AP113 Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest Sakamoto T., Asai Y., Nagao K., Yokota H., Tahara Y., Morimura N., Atsumi T., Nara S., Hase M. Trauma and Resuscitation Center, Teikyo University, SAVE-J Study Group, Japan Purpose of the study: This study is designed to examine the efficacy of extracorporeal cardiopulmonary resuscitation (ECPR) for patients in out-of hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as initial rhythm which is resistant by conventional advanced life support (ALS). Materials and methods: This study was conducted as multicenter non-randomized prospective cohort study. Hypothesis is that the outcome of OHCA with initial shockable rhythm (VT or pulseless VT) is similar between ECPR and conventional ALS. Fifty tertiary emergency hospitals were participated in this study during from September 2009 to March 2010. Patient inclusion criteria were (1) VF or VT as initial rhythm on scene, (2) cardiac arrest on arrival at hospital, (3) within 45 min from a call to an arrival of hospital, and 4) non-ROSC by conventional ALS during 15 min after an arrival at hospital. Exclusion criteria are (1) age: <19 or >75 yrs, (2) poor activities of daily livings, (3) non-cardiac verified cardiac arrest, and (4) hypothermia. According to the inclusion criteria, ECPR was adopted for OHCA in 27 hospitals (ECPR group) and conventional ALS was planned in 23 hospitals (non-ECPR group). We compare ECPR group and non-ECPR group with the proportion of patients with favorable outcome (CPC1 or 2) assessed with the Glasgow-Pittsburgh Categories at 1 month. Results: One hundred and three patients of ECPR group and 67 patients of non-PCPS group were enrolled in this study. The favorable outcome rate in ECPR group was statistically higher than the rate in non-ECPR group (15.9% vs 0.0% p < 0.01). Conclusions: In an interim report from Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan (SAVE-J), ECPR can bring a better outcome of out-of hospital cardiac arrest with initial shockable rhythm than conventional ALS. doi:10.1016/j.resuscitation.2010.09.258
Abstracts / Resuscitation 81S (2010) S1–S114
AP110
AP112
Injuries caused by the autopulse and LUCAS II resuscitation systems compared to manual chest compressions
Less invasive cardiopulmonary bypass for rapid and safe method of therapeutic hypothermia in Japan
Truhlar A. 1,2 , Hejna P. 3 , Zabka L. 1 , Zatopkova L. 3 , Cerny V. 2,4
Kaji A., Morimoto K., Hosomi S., Suehiro S., Ishikawa J., Fuke A., Arimoto H., Miyaichi T., Kan M., Rinka H.
1 Hradec
Kralove Region Emergency Medical Service, Hradec Kralove, Czech Republic 2 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic 3 Institute of Legal Medicine, Charles University Prague, Faculty of Medicine Hradec Kralove, Czech Republic 4 Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada Introduction: Mechanical chest compression devices provide an alternative to manual CPR but may cause injuries.1,2 Our study aimed to compare injuries caused by the AutoPulse (Zoll, USA), LUCAS II (Jolife, Sweden), and manual CPR in both survivors and nonsurvivors of out-of-hospital cardiac arrest (OHCA). Methods: This was a prospective study including nontraumatic OHCAs from January 1st to April 30th, 2010. Two EMS units were equipped with two different mechanical devices. The AutoPulse (A-CPR) was located in a helicopter dispatched predominantly into rural areas, while the LUCAS II (L-CPR) was used by a physician response unit in the city. Manual CPR (M-CPR) was performed if an ambulance with no device was dispatched. The survivors underwent physical examination and a thoracic X-ray, nonsurvivors were autopsied. Data were analyzed using Fisher’s exact test. Results: CPR was attempted in thirty patients: A-CPR 8, L-CPR 11, and M-CPR 11. Injuries were observed in 7/8 (87.5%) in A-CPR, 8/11 (72.7%) in L-CPR, and 3/11 (27.3%) in M-CPR group (P = 0.02). Sternal fractures were present in 3/8, 4/11, and 1/11 (P = 0.33), multiple rib fractures (≥3) in 4/8, 6/11, and 2/11 (P = 0.25), and mediastinal haematomas in 5/8, 2/11, and 0/11 patients (P = 0.003). Pericardial effusions (2 pts) and adventitial aortic haematomas (4 pts) were observed in A-CPR group only (P = 0.06 and 0.002). There was found one cardiac tamponade considered to be primary cause of OHCA. Neither pulmonary nor abdominal injuries were observed. There were 1/8 (12.5%), 1/11 (9.1%), and 4/11 (36.4%) patients discharged from hospital [CPC 1–2] (P = 0.33). Preliminary results of this study are limited by its size and prior BLS (90.0%) whose complications are difficult to separate from device associated injuries. Conclusion: Use of mechanical chest compression devices was associated with increased incidence of injuries compared to manual CPR but surprisingly also with a trend to worse survival. References 1. Perkins GD, Brace S, Gates S. Mechanical chest-compression devices: current and future roles. Curr Opin Crit Care 2010;16:203–10. 2. de Rooij PP, Wiendels DR, Snellen JP. Fatal complication secondary to mechanical chest compression device. Resuscitation 2009;80:1214–5. doi:10.1016/j.resuscitation.2010.09.255 AP111 Implementation of a mechanical compression device as standard equipment in a large, urban ambulance system Satterlee P.A. 1 , Boland L.L. 2 , Johnson P. 2 , Hagstrom S.G. 1 , Page D.I. 1 , Lick C.J. 1 1 Allina 2
Medical Transportation, St. Paul, Minnesota, USA Center for Healthcare Innovation, Allina Hospitals & Clinics, Minneapolis, Minnesota, USA
Purpose: Since 2005, emphasis has been placed on delivering consistent, uninterrupted chest compressions during treatment of cardiac arrest. Research has shown that chest compressions performed manually are often slower than recommended and compromised by frequent interruptions, and that mechanical compression devices offer a superior alternative. We implemented a mechanical compression device (LUCASTM , Jolife) as standard equipment on every advanced life support (ALS) ambulance in our service, to be used in every instance where resuscitation was attempted. Setting and methods: Allina Medical Transportation provides advanced and basic life support services to 1,000,000 people in 80 communities in and around Minneapolis, MN, employing nearly 300 paramedics and emergency medical technicians. After pilot testing 10 mechanical compression devices in first responder vehicles, receiving facilities, and ALS ambulances, we decided to expand access by equipping every ALS ambulance with the device. We purchased 30 units, trained all ambulance personnel within 3 months, established an operational plan for maintenance, and initiated data collection on use. Results: During a 2-year period, the mechanical compression device was used on approximately 400 patients, and 50 instances where patients were incompatible with the device were documented. We found use of the device to be simple and effective, and few problems were encountered by providers when using the device. Overall, staff and first responders are highly satisfied with the device, despite initially experiencing some minor operational challenges with storing and powering the machine. Conclusions: Optimal chest compressions are essential for effective resuscitation of victims of cardiac arrest. Broad application of an air-powered mechanical compression device across a large, urban ambulance service is feasible and likely improves the quality of chest compressions. The device we have selected is easy to learn, simple to use, and has become the standard of care for cardiac arrest victims in the communities we serve. doi:10.1016/j.resuscitation.2010.09.256
Emergency and Critical Care Medical Centre, Osaka City General Hospital, Japan Purpose of study: Therapeutic hypothermia results good neurological outcome after out-of-hospital cardiac arrest. But during introduction and maintenance stage around the proper temperature, we often encountered with many difficulties (shivering, poor peripheral circulation, arrhythmias and other life-threatening complications). So we introduce Less Invasive Cardiopulmonary Bypass (LICH) after Recovery Of Spontaneous Contraction (ROSC) patients. Conservative surface cooling methods and LICH methods are retrospectively evaluated in the point of view of easiness, complications and disadvantages during both introduction and maintenance periods. Materials and methods: For 36 months (2007–2009), 23 cases were introduced by the conservative surface cooling methods (group C). 17 cases were actively introduced by LICH at Emergency Room (group L). Group L had been maintained with using LICH during ICU for 24–48 h. Group C was maintained with the conservative cooling methods. Therapeutic hypothermia period were continued for 24–48 h in both groups. Neurological outcome, complications and speed for the proper body temperature were evaluated retrospectively. Results: Both groups had no difference of neurological outcome. Group L have obviously quickly achieved the proper body temperature. Catecholamimes were less used in group L. Conclusion: LICH method using child bypass circuit system is preferable for introduction and maintenance of therapeutic hypothermia therapy for ROSC patients. The reasons are: 1. Rapidly achieved to hypothermia 2. Easy to control the body temperature 3. Easy to encourage scirculation without any catecholamine supports doi:10.1016/j.resuscitation.2010.09.257 AP113 Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest Sakamoto T., Asai Y., Nagao K., Yokota H., Tahara Y., Morimura N., Atsumi T., Nara S., Hase M. Trauma and Resuscitation Center, Teikyo University, SAVE-J Study Group, Japan Purpose of the study: This study is designed to examine the efficacy of extracorporeal cardiopulmonary resuscitation (ECPR) for patients in out-of hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as initial rhythm which is resistant by conventional advanced life support (ALS). Materials and methods: This study was conducted as multicenter non-randomized prospective cohort study. Hypothesis is that the outcome of OHCA with initial shockable rhythm (VT or pulseless VT) is similar between ECPR and conventional ALS. Fifty tertiary emergency hospitals were participated in this study during from September 2009 to March 2010. Patient inclusion criteria were (1) VF or VT as initial rhythm on scene, (2) cardiac arrest on arrival at hospital, (3) within 45 min from a call to an arrival of hospital, and 4) non-ROSC by conventional ALS during 15 min after an arrival at hospital. Exclusion criteria are (1) age: <19 or >75 yrs, (2) poor activities of daily livings, (3) non-cardiac verified cardiac arrest, and (4) hypothermia. According to the inclusion criteria, ECPR was adopted for OHCA in 27 hospitals (ECPR group) and conventional ALS was planned in 23 hospitals (non-ECPR group). We compare ECPR group and non-ECPR group with the proportion of patients with favorable outcome (CPC1 or 2) assessed with the Glasgow-Pittsburgh Categories at 1 month. Results: One hundred and three patients of ECPR group and 67 patients of non-PCPS group were enrolled in this study. The favorable outcome rate in ECPR group was statistically higher than the rate in non-ECPR group (15.9% vs 0.0% p < 0.01). Conclusions: In an interim report from Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan (SAVE-J), ECPR can bring a better outcome of out-of hospital cardiac arrest with initial shockable rhythm than conventional ALS. doi:10.1016/j.resuscitation.2010.09.258