Running head: EFFECTIVENESS OF MECHANICAL CARDIOPULMONARY 1

Effectiveness of Mechanical Cardiopulmonary Resuscitation Devices

Andrew Harriman

University of South Florida

EFFECTIVENESS OF MECHANICAL CARDIOPULMONARY 2

Abstract

Clinical Problem: Patients suffering from cardiac arrest have only minutes for cardiopulmonary

resuscitation (CPR) to be started before permanent brain injury or death occur. The goal of chest

compressions during CPR is to circulate blood to the brain, heart and other vital organs after the

heart has stopped pumping effectively or stopped altogether.

Objective: To determine if mechanical CPR devices such as the LUCAS CPR or AutoPulse

provide chest compressions that circulate blood to the brain as effectively as manual

compressions (those provided by humans). PubMed, CINAHL, Google Scholar, EMBASE and

systematic reviews were used to obtain randomized controlled trials (RCTs) about the use and

effectiveness of mechanical CPR devices in providing effective perfusion in the patient in

cardiac arrest. Key search terms used were mechanical CPR during cardiac arrest, CPR devices

and survival rates using mechanical CPR.

Results: There are not currently any officially recognized or published guidelines for the use of

mechanical CPR devices in patients suffering sudden cardiac arrest (SCA).

Conclusion: Mechanical CPR devices do not consistently improve the mortality of patients

suffering from SCA. In some cases, they even increase the mortality rates. Until improvements

to these devices are made, hands-on CPR appears to be the most effective way of circulating

blood to the vital organs in a patient suffering a SCA.

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Effectiveness of Mechanical Cardiopulmonary Resuscitation Devices

According to the American Heart Association (AHA), there were more than 350,000

cases of Out-of-Hospital Cardiac Arrest (OHCA) and 209,000 cases of In-Hospital Cardiac

Arrest (IHCA) for a combined total of more than 559,000 cardiac arrests in the United States

(U.S.) in 2016 alone (American Heart Association, 2017). OCHA and ICHA are often

collectively referred to as sudden cardiac arrest (SCA). Sudden cardiac arrest is the single

biggest cause of natural death in the U.S. (Cleveland Clinic, 2017). Cardiopulmonary

resuscitation (CPR) is considered the most important intervention for SCA survival. Since

sudden cardiac arrest can happen to anyone, anywhere at anytime, it is critical that effective

chest compressions (CC) be provided as quickly as possible. This paper evaluates the

effectiveness of mechanical CPR devices. Among patients suffering from SCA, does the use of

MCPRDs, compared to manual chest compressions, decrease the mortality in SCA patients to

discharge?

Literature Search

PubMed, CINAHL, Google Scholar, EMBASE and systematic reviews were used to

obtain randomized controlled trials (RCTs) about the use and effectiveness of mechanical CPR

devices in providing effective perfusion in the patient in cardiac arrest. Key search terms used

were: mechanical CPR during cardiac arrest, CPR devices and survival rates using mechanical

CPR.

Literature Review

Randomized control trials were obtained to judge the effectiveness of mechanical CPR

devices in improving outcomes in patients suffering from SCA. No standard guidelines for use

outside of manufacturers recommendations are currently available. Using a RCT, Rubertsson et

EFFECTIVENESS OF MECHANICAL CARDIOPULMONARY 4

al. (2014) investigated whether using the LUCAS CPR device to provide mechanical CCs

improved patient survivability to hospital discharge versus manual compressions. Exclusion

criteria for this study included patients under the age of 18, a traumatic arrest (i.e. hanging),

pregnancy and body sizes that were not compatible with the device. A total of 2,589 patients

were randomly assigned to the control and intervention groups. Out of the 208 patients who

survived to discharge, 100 belonged to the control group while 108 received the intervention.

Survivability to hospital discharge was nearly identical between the two groups with 8.3% of

mechanical CC versus 7.8% of manual CC patients. The main weakness of this study is that the

subjects in each group did not have similar baseline clinical variables. Strengths of this study

were randomization of subjects, a large population of qualifying subjects, reasons why subjects

did not complete the study and the length of time of that follow-up assessments were conducted.

In their 2005 study, Casner, Andersen, and Isaacs (2005) performed a RCT to study the

effectiveness of the AutoPulse cardiopulmonary resuscitation (A-CPR) device in achieving

return of spontaneous circulation (ROSC) by performing mechanical CC on patients suffering

OHCA. One hundred sixty-two patients were evaluated during the study. A-CPR was utilized for

sixty-nine patients while ninety-three patients received manual chest compressions. Patients from

the two groups were matched by age, gender and initial presenting EKG rhythm. Patients

suffering OHCA who received CC via A-CPR had a higher survival rate (39%) than patients

who received only manual CC (29%). The strengths of this study include using an examiner,

who was separated from all other aspects of the study, to match patients to the inclusion criteria.

One weakness of this RCT is that reasons why people did not complete the study were not

included.
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Hallstrom et al. (2006) conducted a RCT comparing 4-hour survivability in OCHA

patients who received CC from the automated load-distributing band (LDB-CPR) against those

who received manual CC. A sum total of 767 eligible patients were used in the study. The

intervention group (n=394) received CC via the LDB-CPR while the control group (n=373)

received manual compressions. There was no differentiation in 4-hour survival between those

who received CC via the LDB-CPR and those who received manual CC (n=767; 26.4% vs.

24.7%, respectively; P=.62). However, patients who received mechanical CCs via the LDB-CPR

actually experienced worsened neurological outcomes by hospital discharge. Exclusion factors

were not included in the study which is a major weakness.

In their 2015 landmark RCT, Perkins et al. (2015) studied the efficacy of the LUCAS-2

mechanical CPR device in achieving ROSC in patients experiencing OHCA and measured

survival rates 30 days post-resuscitation. The study utilized 91 different ambulance stations

throughout the UK over a 38-month period. Exclusion criteria for this study included patients

under the age of 18, a traumatic arrest of any etiology and pregnant patients. Of the 1652 patients

enrolled in the intervention group (LUCAS device) 104 (6%) survived 30-days post-resuscitation

versus 193 (7%) of the 2819 patients who belonged to the control group (manual CC). A major

strength of this RCT is that subjects were randomly assigned to their respective groups. Another

strength includes paramedics involved in the study being thoroughly trained in the use of the

LUCAS device to include troubleshooting, with periodic refreshers. There arent any major

weaknesses of this study.

Synthesis

Rubertsson et al. (2014) demonstrated that using the LUCAS device to provide manual

CCs in patients suffering from SCA does not improve patient outcomes or ROSC. Additionally,
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Perkins et al. (2015) landmark study came to the same conclusion about the effectiveness of the

LUCAS device. However, Casner et al. (2005) determined that there was a 10% increase in the

survivability of patients suffering from SCA when CCs were delivered using the A-CPR device.

This is a large advantage over the LUCAS device. The study conducted by Hallstrom et al.

(2006) had the exact opposite outcome. Implementation of the automated LDB-CPR device as

utilized for this study resulted in poor neurological outcomes and a tendency towards lower

survival rates than in patients who received manual CPR. Change in design and or mechanical

components used during manufacturing may be necessary to make the device viable for use on

real patients suffering SCA.

Clinical Recommendations

The idea and theory behind automated CPR devices is a step in the right direction.

Currently, EMS systems that use automated devices typically use them on every patient in

cardiac arrest because it frees up EMTs and paramedics and allows them to focus on other

aspects of patient care. However, the varied results from the above studies prove that more

research is needed to make sure these devices can consistently provide improved outcomes in

patients suffering from SCA. Until that research is conducted these devices should only be used

in situations where prolonged CPR is necessary and few resources are available. Examples

include extended transport times to a hospital where CPR quality will greatly diminish due to

rescuer fatigue and during a natural disaster where rescuers who can perform CPR will be in

short supply.
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References

American Heart Association. (2017). CPR & First Aid: Emergency Cardiovascular Care.

Retrieved March 6, 2017 from http://cpr.heart.org/AHAECC/CPRAndECC/

General/UCM_477263_Cardiac-Arrest-Statistics.jsp

Casner, M., Andersen, D., Isaacs, S.M. (2005). The impact of a new CPR assist device on rate of

return of spontaneous circulation in out-of-hospital cardiac arrest. Prehospital Emergency

Care, 9(1), 61-67. doi:10.1080/10903120590891714

Cleveland Clinic. (2017). Sudden Cardiac Death (Sudden Cardiac Arrest). Retrieved March 6

2017 from http://my.clevelandclinic.org/health/articles/sudden-cardiac-death

Hallstrom, A., Rea, T.D., Sayre, M.R., Christenson, J., Anton, A.R., Mosesso, V.N., . . . Cobb,

L. (2006). Manual chest compression vs use of an automated chest compression device

during resuscitation following out-of-hospital cardiac arrest: A randomized trial. JAMA,

295(22), 2620-2628. doi:10.1001/jama.295.22.2620

Perkins, G., Lall, R., Quinn, T., Deakin, C., Cooke, M., Horton, J., . . . Gates, S. (2015).

Mechanical versus manual chest compression for out-of-hospital cardiac arrest

(PARAMEDIC): A pragmatic, cluster randomised controlled trial. The Lancet,

385(9972), 947-955. doi:10.1016/S0140-6736(14)61886-9

Rubertsson, S., Lindgren, E., Smell, D., Ostlund, O., Silfverstolpe, J., Lichtveld, R.,...Karlsten,

R. (2014). Mechanical Chest Compressions and Simultaneous Defibrillation vs

Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: The

LINC Randomized Trial. JAMA, 311(1), 53-61. doi:10.1001/jama.2013.282538