Gyory Robert A, Buchle Scott E, Rodgers David, Lubin Jeffrey S
Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Penn State Health Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, Pennsylvania.
West J Emerg Med. 2017 Apr;18(3):437-445. doi: 10.5811/westjem.2017.1.32575. Epub 2017 Mar 14.
High-quality cardiopulmonary resuscitation (CPR) is critical for successful cardiac arrest outcomes. Mechanical devices may improve CPR quality. We simulated a prehospital cardiac arrest, including patient transport, and compared the performance of the LUCAS™ device, a mechanical chest compression-decompression system, to manual CPR. We hypothesized that because of the movement involved in transporting the patient, LUCAS would provide chest compressions more consistent with high-quality CPR guidelines.
We performed a crossover-controlled study in which a recording mannequin was placed on the second floor of a building. An emergency medical services (EMS) crew responded, defibrillated, and provided either manual or LUCAS CPR. The team transported the mannequin through hallways and down stairs to an ambulance and drove to the hospital with CPR in progress. Critical events were manually timed while the mannequin recorded data on compressions.
Twenty-three EMS providers participated. Median time to defibrillation was not different for LUCAS compared to manual CPR (p=0.97). LUCAS had a lower median number of compressions per minute (112/min vs. 125/min; IQR = 102-128 and 102-126 respectively; p<0.002), which was more consistent with current American Heart Association CPR guidelines, and percent adequate compression rate (71% vs. 40%; IQR = 21-93 and 12-88 respectively; p<0.002). In addition, LUCAS had a higher percent adequate depth (52% vs. 36%; IQR = 25-64 and 29-39 respectively; p<0.007) and lower percent total hands-off time (15% vs. 20%; IQR = 10-22 and 15-27 respectively; p<0.005). LUCAS performed no differently than manual CPR in median compression release depth, percent fully released compressions, median time hands off, or percent correct hand position.
In our simulation, LUCAS had a higher rate of adequate compressions and decreased total hands-off time as compared to manual CPR. Chest compression quality may be better when using a mechanical device during patient movement in prehospital cardiac arrest patient.
高质量的心肺复苏（CPR）对于心脏骤停的成功救治至关重要。机械设备可能会提高心肺复苏的质量。我们模拟了院外心脏骤停情况，包括患者转运，并将机械胸外按压 - 减压系统LUCAS™设备与人工心肺复苏的性能进行了比较。我们假设，由于患者转运过程中的移动，LUCAS将提供更符合高质量心肺复苏指南的胸外按压。
我们进行了一项交叉对照研究，将一个记录人体模型放置在建筑物的二楼。一支紧急医疗服务（EMS）团队做出响应，进行除颤，并提供人工或LUCAS心肺复苏。团队将人体模型通过走廊和楼梯运送到救护车，并在进行心肺复苏的同时开车前往医院。关键事件由人工计时，而人体模型记录按压数据。
23名EMS提供者参与了研究。与人工心肺复苏相比，LUCAS的除颤中位时间没有差异（p = 0.97）。LUCAS每分钟的按压中位数较低（分别为112次/分钟和125次/分钟；IQR分别为102 - 128和102 - 126；p < 0.002），这与当前美国心脏协会的心肺复苏指南更一致，且按压充分率百分比更高（分别为71%和40%；IQR分别为21 - 93和12 - 88；p < 0.002）。此外，LUCAS的按压深度充分百分比更高（分别为52%和36%；IQR分别为25 - 64和29 - 39；p < 0.007），总脱手时间百分比更低（分别为15%和20%；IQR分别为10 - 22和15 - 27；p < 0.005）。在按压释放深度中位数、完全释放按压百分比、脱手中位时间或正确手部位置百分比方面，LUCAS与人工心肺复苏没有差异。
在我们的模拟中，与人工心肺复苏相比，LUCAS具有更高的充分按压率且总脱手时间减少。在院外心脏骤停患者转运过程中使用机械设备时，胸外按压质量可能更好。
