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Mechanical external CPR during OHCA
Abstracts / Resuscitation 85S (2014) S15–S121
carried out from the time the patient entered the ambulance until the time the ambulance arrived at the hospital. Regular oscillometric BP monitoring was carried out simultaneously. Primary outcome was to investigate the feasibility of the CNAP device during ambulance transfer. This included secure mounting of the device and the time used until data was displayed by the CNAP. Complications related to measurements were noted. Secondary outcome was to compare the agreement of the CNAP and a traditional oscillometric BP measurement. Results: The CNAP device could be securely mounted in the ambulances using a Weinmann Board and we observed no interactions with iv lines, oxygen tubes or other devices applied. Measurements were established with no or little delay compared to conventional oscillometric measurement. There was acceptable correlation between measurements. In one case the CNAP was not able to measure BP due to low BP. In another case BP could not be measured, probably due to the patient’s extremities being cold. No complication was observed. Conclusions: During ambulance transfer the CNAP device is easy and fast to use. It provides valuable information on patients with unstable BP, however with some limitations. http://dx.doi.org/10.1016/j.resuscitation.2014.03.221 AP173 A comparative evaluation on the outcomes of cardiac resuscitation by using manual CPR and mechanical CPR Rakesh Jalali 1,∗ , Andrzej Zawadzki 2 1
Emergency Department, Regional Specialist Hospital, Olsztyn, Warmia and Masuria, Poland 2 Faculty of Medical Sciences, University of Warmia and Masuria, Poland
Purpose of the study: Quality of CPR is a major factor affecting survival in cardiac arrest. As quality of manual CPR rarely meets standards, interest in chest compression devices increase. Two of the most tested mechanical CPR devices are LUCAS and AutoPulse (ZOLL). In a recently concluded trial that used AutoPulse it was shown that the AutoPulse is equivalent to high quality manual CPR performed by constantly re-trained personnel. The aim of this study is to test the efficacy of the AutoPulse, in out-of hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients. Materials and methods: In our prospective observational study we selected patients, aged between 18 and 85, both sexes excluding pregnant women. We compared AutoPulse (AP-CPR) with Manual CPR (M-CPR) in cardiac arrest patients. Effectiveness of each method was measured by ROSC, 6 h survival, blood pressure, endtidal carbon dioxide (etCO2 ) and SpO2 . Results: We included in total 175 patients 58 M-CPR (44 OHCA, 14 IHCA) and 117 AP-CPR (51 OHCA, 66 IHCA). Patients receiving AP-CPR had significant higher ROSC and 6 h survival compared to M-CPR. ROSC 46% vs. 20.8 and 6 h survival 21% vs. 8%. Compared with M-CPR, AP-CPR produced higher mean, minimum and average values of etCO2 (25–58 mmHg and 20–32 mmHg). Conclusion: Our results are in accordance with some of the earlier studies and indicate that the AutoPulse using a Load Distribution Band mechanism is more effective than manual CPR and are likely to play an increasingly important role in CPR events in both In Hospital as well as Out of Hospital Cardiac Arrest patients. http://dx.doi.org/10.1016/j.resuscitation.2014.03.222
S89
AP174 Mechanical external CPR during OHCA Thierry Schwetterle, Sandrine Duranton ∗ Service Departemental Incendie et Secours, Val d’oise, France Introduction: The mechanical CPR project was initiated to improve cardiac arrests outcomes from EMS patients. The project also aimed to integrate organ retrieval following cardiac arrest and ECMO. Devices and methodology: For mechanical CPR we used the LDB (ZOLL, AutoPulse) and apart from the AED ECG recordings, the main observations focused on ROSC and survival. The secondary criteria included all adverse events due to Mechanical CPR. Results: Over a period of 6 years we analyzed 2250 patients who suffered from OHCA. The average duration of all resuscitations was 28 min. Compared to the National Reference Data Base in France, patients receiving mechanical CPR showed slightly higher ROSC rates 17.9% vs. 14.7%. Survival to hospital discharge with AutoPulse in all rhythms categories was 10.6%. 58 patients were selected as organ donor allowing 30 kidney transplants, 3 hepatic transplants and 20 patients were connected to ECMO with an additional survival rate of 5%. From the 2250 patients, 19 (0.8%) had minor side effects (moderated hemoptysis). The hospitals reported 15 (0.6%) patients with thoraco-abdominal complications (5 resuscitation troubles). Conclusion: In this observational study we conclude that the use of the LDB (ZOLL, AutoPulse) device contributes significantly to optimize CPR in an EMS environment. Mechanical CPR did not significantly improved survival rates but this may be due to fact like lack of early defibrillation and early CPR specifically in France. The use of the LDB is encouraging concerning ROSC, organ retrieval and ECMO use. Adverse events were rare and manageable, there for we consider the AutoPulse safe and effective. Our crew members (doctors and rescuers) benefit from the positive effects of Mechanical CPR as the AutoPulse is easy to use, deployment goes quickly and mechanical incidents/complications are minimal. http://dx.doi.org/10.1016/j.resuscitation.2014.03.223
Paediatric Life Support AP175 Different respiratory rates during resuscitation in a pediatric animal model of asphyxial cardiopulmonary arrest. Changes in ventilation and oxygenation values Jorge López ∗ , Sarah Nicole Fernández, Javier Urbano, Rafael González, María José Solana, Jesús López-Herce, Blanca Toledo, Amelia Caridad Sánchez, Santiago Mencía Gregorio Mara˜ nón General University Hospital, Madrid, Spain Objectives: 10–12 respirations per minute (rpm) is the recommended respiratory rate (RR) for pediatric resuscitation. However, there are no data that support this recommendation. The aim of this study is to compare changes in ventilation and oxygenation with three RR (10, 20 and 30 rpm). Materials and methods: An experimental model of asphyxia cardiopulmonary arrest (CA) in 46 piglets (median weight 9.5 kg) was performed. Resuscitation with three different RR was carried out. Mean artery pressure (MAP), arterial blood gases and end-tidal
carried out from the time the patient entered the ambulance until the time the ambulance arrived at the hospital. Regular oscillometric BP monitoring was carried out simultaneously. Primary outcome was to investigate the feasibility of the CNAP device during ambulance transfer. This included secure mounting of the device and the time used until data was displayed by the CNAP. Complications related to measurements were noted. Secondary outcome was to compare the agreement of the CNAP and a traditional oscillometric BP measurement. Results: The CNAP device could be securely mounted in the ambulances using a Weinmann Board and we observed no interactions with iv lines, oxygen tubes or other devices applied. Measurements were established with no or little delay compared to conventional oscillometric measurement. There was acceptable correlation between measurements. In one case the CNAP was not able to measure BP due to low BP. In another case BP could not be measured, probably due to the patient’s extremities being cold. No complication was observed. Conclusions: During ambulance transfer the CNAP device is easy and fast to use. It provides valuable information on patients with unstable BP, however with some limitations. http://dx.doi.org/10.1016/j.resuscitation.2014.03.221 AP173 A comparative evaluation on the outcomes of cardiac resuscitation by using manual CPR and mechanical CPR Rakesh Jalali 1,∗ , Andrzej Zawadzki 2 1
Emergency Department, Regional Specialist Hospital, Olsztyn, Warmia and Masuria, Poland 2 Faculty of Medical Sciences, University of Warmia and Masuria, Poland
Purpose of the study: Quality of CPR is a major factor affecting survival in cardiac arrest. As quality of manual CPR rarely meets standards, interest in chest compression devices increase. Two of the most tested mechanical CPR devices are LUCAS and AutoPulse (ZOLL). In a recently concluded trial that used AutoPulse it was shown that the AutoPulse is equivalent to high quality manual CPR performed by constantly re-trained personnel. The aim of this study is to test the efficacy of the AutoPulse, in out-of hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients. Materials and methods: In our prospective observational study we selected patients, aged between 18 and 85, both sexes excluding pregnant women. We compared AutoPulse (AP-CPR) with Manual CPR (M-CPR) in cardiac arrest patients. Effectiveness of each method was measured by ROSC, 6 h survival, blood pressure, endtidal carbon dioxide (etCO2 ) and SpO2 . Results: We included in total 175 patients 58 M-CPR (44 OHCA, 14 IHCA) and 117 AP-CPR (51 OHCA, 66 IHCA). Patients receiving AP-CPR had significant higher ROSC and 6 h survival compared to M-CPR. ROSC 46% vs. 20.8 and 6 h survival 21% vs. 8%. Compared with M-CPR, AP-CPR produced higher mean, minimum and average values of etCO2 (25–58 mmHg and 20–32 mmHg). Conclusion: Our results are in accordance with some of the earlier studies and indicate that the AutoPulse using a Load Distribution Band mechanism is more effective than manual CPR and are likely to play an increasingly important role in CPR events in both In Hospital as well as Out of Hospital Cardiac Arrest patients. http://dx.doi.org/10.1016/j.resuscitation.2014.03.222
S89
AP174 Mechanical external CPR during OHCA Thierry Schwetterle, Sandrine Duranton ∗ Service Departemental Incendie et Secours, Val d’oise, France Introduction: The mechanical CPR project was initiated to improve cardiac arrests outcomes from EMS patients. The project also aimed to integrate organ retrieval following cardiac arrest and ECMO. Devices and methodology: For mechanical CPR we used the LDB (ZOLL, AutoPulse) and apart from the AED ECG recordings, the main observations focused on ROSC and survival. The secondary criteria included all adverse events due to Mechanical CPR. Results: Over a period of 6 years we analyzed 2250 patients who suffered from OHCA. The average duration of all resuscitations was 28 min. Compared to the National Reference Data Base in France, patients receiving mechanical CPR showed slightly higher ROSC rates 17.9% vs. 14.7%. Survival to hospital discharge with AutoPulse in all rhythms categories was 10.6%. 58 patients were selected as organ donor allowing 30 kidney transplants, 3 hepatic transplants and 20 patients were connected to ECMO with an additional survival rate of 5%. From the 2250 patients, 19 (0.8%) had minor side effects (moderated hemoptysis). The hospitals reported 15 (0.6%) patients with thoraco-abdominal complications (5 resuscitation troubles). Conclusion: In this observational study we conclude that the use of the LDB (ZOLL, AutoPulse) device contributes significantly to optimize CPR in an EMS environment. Mechanical CPR did not significantly improved survival rates but this may be due to fact like lack of early defibrillation and early CPR specifically in France. The use of the LDB is encouraging concerning ROSC, organ retrieval and ECMO use. Adverse events were rare and manageable, there for we consider the AutoPulse safe and effective. Our crew members (doctors and rescuers) benefit from the positive effects of Mechanical CPR as the AutoPulse is easy to use, deployment goes quickly and mechanical incidents/complications are minimal. http://dx.doi.org/10.1016/j.resuscitation.2014.03.223
Paediatric Life Support AP175 Different respiratory rates during resuscitation in a pediatric animal model of asphyxial cardiopulmonary arrest. Changes in ventilation and oxygenation values Jorge López ∗ , Sarah Nicole Fernández, Javier Urbano, Rafael González, María José Solana, Jesús López-Herce, Blanca Toledo, Amelia Caridad Sánchez, Santiago Mencía Gregorio Mara˜ nón General University Hospital, Madrid, Spain Objectives: 10–12 respirations per minute (rpm) is the recommended respiratory rate (RR) for pediatric resuscitation. However, there are no data that support this recommendation. The aim of this study is to compare changes in ventilation and oxygenation with three RR (10, 20 and 30 rpm). Materials and methods: An experimental model of asphyxia cardiopulmonary arrest (CA) in 46 piglets (median weight 9.5 kg) was performed. Resuscitation with three different RR was carried out. Mean artery pressure (MAP), arterial blood gases and end-tidal