Improved neurologically intact survival with the use of an automated, load-distributing band chest compression device for cardiac arrest presenting to the emergency department

ABSTRACT: INTRODUCTION: It has been unclear if mechanical cardiopulmonary resuscitation (CPR) is a viable alternative to manual CPR. We aimed to compare resuscitation outcomes before and after switching from manual CPR to load-distributing band (LDB) CPR in a multi-center emergency department (ED) trial. METHODS: We conducted a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. At these two urban EDs, systems were changed from manual CPR to LDB-CPR. Primary outcome was survival to hospital discharge, with secondary outcome measures of return of spontaneous circulation, survival to hospital admission and neurological outcome at discharge. RESULTS: A total of 1,011 patients were included in the study, with 459 in the manual CPR phase (January 01, 2004, to August 24, 2007) and 552 patients in the LDB-CPR phase (August 16, 2007, to December 31, 2009). In the LDB phase, the LDB device was applied in 454 patients (82.3%). Patients in the manual CPR and LDB-CPR phases were comparable for mean age, gender and ethnicity. The mean duration from collapse to arrival at ED (min) for manual CPR and LDB-CPR phases was 34:03 (SD16:59) and 33:18 (SD14:57) respectively. The rate of survival to hospital discharge tended to be higher in the LDB-CPR phase (LDB 3.3% vs Manual 1.3%; adjusted OR, 1.42; 95% CI, 0.47, 4.29). There were more survivors in LDB group with cerebral performance category 1 (good) (Manual 1 vs LDB 12, P=0.01). Overall performance category 1 (good) was Manual 1 vs LDB 10, P=0.06. CONCLUSIONS: A resuscitation strategy using LDB-CPR in an ED environment was associated with improved neurologically intact survival on discharge in adults with prolonged, non-traumatic cardiac arrest.     

The V-Quick patch versus the standard 12-lead ECG system: time is the essence

Introduction

The V-Quick patch template system is compared with the standard 12-lead electrocardiogram (ECG) acquisition technique in this paper. The objectives of the study were: (a) to study and compare the time taken to produce the printed 12-lead ECG and (b) to look at the level of agreement when the ECGs were compared by two blinded, independent assessors.

Methods

One hundred and fifty each of male and female volunteers signed an informed consent form to participate in the clinical study. Nurses were put through a 4-h training session to familiarise themselves with the V-Quick patch system. The timings were measured with a stopwatch with the specific start and end points defined. The final ECG printouts were then compared by two blinded, independent assessors for several set criteria.

Results

The V-Quick patch system was proved to be significantly faster than the standard 12-lead system in the acquisition of the ECG in both male and female volunteers. The time taken in male volunteers was also noted to be significantly faster than in female volunteers.

Conclusion

The two assessors shared a 100% agreement level when comparing the ECGs acquired by both techniques in the same individual (intra-assessor agreement) and when each ECG was read by the two assessors separately (inter-assessor agreement).     

Improving the quality of cardiopulmonary resuscitation by training dedicated cardiac arrest teams incorporating a mechanical load-distributing device at the emergency department

Objective

Determine if implementing cardiac arrest teams trained with a ‘pit-crew’ protocol incorporating a load-distributing band mechanical CPR device (Autopulse™ ZOLL) improves the quality of CPR, as determined by no-flow ratio (NFR) in the first 10 min of resuscitation.

Methods

A phased, prospective, non-randomized, before–after cohort evaluation. Data collection was from April 2008 to February 2011. There were 100 before and 148 after cases. Continuous video and chest compression data of all study subjects were analyzed. All non-traumatic, collapsed patients aged 18 years and above presenting to the emergency department were eligible. Primary outcome was NFR. Secondary outcomes were return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge.

Main results

After implementation, mean total NFR for the first 5 min decreased from 0.42 to 0.27 (decrease = 0.15, 95% CI 0.10–0.19, p < 0.005), and from 0.24 to 0.18 (decrease = 0.06, 95% CI 0.01–0.11, p = 0.02) for the next 5 min. The mean time taken to apply Autopulse™ decreased from 208.8 s to 141.6 s (decrease = 67.2, 95% CI, 22.3–112.1, p < 0.005). The mean CPR ratio increased from 46.4% to 88.4% (increase = 41.9%, 95% CI 36.9–46.9, p < 0.005) and the mean total NFR for the first 10 min decreased from 0.33 to 0.23 (decrease = 0.10, 95% CI 0.07–0.14, p < 0.005).

Conclusion

Implementation of cardiac arrest teams was associated with a reduction in NFR in the first 10 min of resuscitation. Training cardiac arrest teams in a ‘pit-crew’ protocol may improve the quality of CPR at the ED.