Ahed Al Najjar, FAHAFellow American Heart Association

Director, Life Support Training Center, KSU

Vic President of Jordan Association of EMS

AREMT EMS Board Director

United Nations – UNOPS EMS Consultant (previous)

Ahed.Najjar@aremt.com.au

• Survival from sudden cardiac arrest (SCA) is zero

percent if external chest compressions (CPR) are not

performed.

• Since the 1950s, when Dr. Peter Safar first described

the modern technique of pushing on the chest to

create blood flow, researchers have worked to

optimize manual compression depth and rate while

trainers have trained millions of people worldwide in

CPR.

• Along with automated external defibrillators and

basic airway management, CPR is considered a

fundamental component of basic life support (BLS) in

cardiac resuscitation.

Introduction

Background

• From the 1970s to the late 90s, much attention was

given to advance life support (ALS).

• However, complex and complicated techniques were

not improving survival rates.

• In 2005, the American Heart Association

recommended for cardiac arrest management:

– minimally interrupted chest compressions

– adequate depth and sufficient rate

– ensure full chest recoil

Manual Chest Compressions

• rescuer kneeling upright next to the

victim, using two outstretched arms

placed over the sternum, and bending

at the hips to create a downward force

• The rescuer returns back to an upright

position, releasing all pressure off the

chest.

This “duty cycle” is repeated at a rate of at least one

hundred times per minute, interrupted every 30

compressions to deliver a small volume of air to

ventilate the lungs.

Manual Chest Compressions

Challenges:

1. Size and weight of rescuer

– Adequacy of compressions

2. The training must be simple enough

to acquire quickly and retain.

Performing CPR is a task that is seldom practiced in real life

by the lay public; even professional rescuers perform CPR at

a much lower frequency than other procedures such as

measuring blood.

Manual Chest Compressions

Challenges:

3. Fatigue during CPR is a major factor.

4. Finally, trying to deliver effective manual chest

compressions during patient extrication and transport is

extremely difficult.

Mechanical Chest CompressionsThe device is an automated, portable, battery-powered

cardiopulmonary resuscitation device and subsequently

purchased and currently manufactured by ZOLL Medical

Corporation.

It is a chest compression device composed of a

constricting band and half backboard that is intended to

be used as an adjunct to CPR during advanced cardiac

life support by professional health care providers.

The device uses a distributing band to deliver the chest

compressions. In literature it is also known as LDB-CPR

(Load Distributing Band-CPR).

Chest compression devices

• As early as the 1960s, the “Thumper” made by Michigan

Instruments used an oxygen-powered piston on an adjustable

arm to deliver compressions.

Chest compression devices

• The Zoll Autopulse

– uses a load-distributing band that is

wrapped around the victim’s chest and

tightened rhythmically by an electrical

motor.

• Physio Control’s LUCAS

– pneumatic or electric

– compresses the chest with a piston

in a more compact configuration.

Pictures are for presentation purposes only. The American Heart Association does not endorse any particular products,

models or manufacturers.

Chest compression devices

Advantages:

• Ensures improved blood flow (squeezes

the entire chest).

• Is fast, easy, and intuitive to start up and

use.

– it automatically calculates the size,

shape, and resistance of each

patient's chest.

• Functions as an "additional person”.

• Ensures clinical safety.

• Ensures rescuer safety during

transport.

Chest compression devices

Disadvantages:

• large-scale scientific studies have not shown

the effectiveness.

• Significant cost of devices.

• Costly replacement parts and maintenance

• It requires significant training and practice to

implement each device with minimal

interruption to CPR during a cardiac arrest

• Several cases have been reported where the

device has caused additional injury to patients

receiving compressions from the device

Study 1: Mechanical vs Manual CPR

• Out-of-hospital cardiopulmonary resuscitation with the

AutoPulseTM system: A prospective observational study with

a new load-distributing band chest compression device.

(Department of Anaesthesiology and Intensive Care Medicine, University

of Bonn, Bonn, Germany in 31 August 2006)

Human Hemodynamics Study: generated CPP was 33%

better than manual CPRAutoPulse tripled survival to hospital discharge

Study 2: Mechanical vs Manual CPR

• Mechanical CPR devices compared to manual CPR during out-

of-hospital cardiac arrest and ambulance transport: a

systematic review. (Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore,

Department of Emergency Medicine, Kaiser Permanente, Sacramento, CA, USA.,Department of Emergency System, Graduate School of Sport System, Kokushikan

University, Tokyo, Japan, Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan, Department of Emergency Medicine, William Beaumont

Hospital, Royal Oak, MI, USA, Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea)

Conclusion

• At this point, researchers neither recommend nor discount

the routine use of mechanical CPR devices in cardiac arrest.

• More research is needed.

• Better training and practice in deploying chest compression

devices may help improve arrest outcomes.

Class IIb Acceptable and useful. Fair to good

evidence provides support.