Comparison of different mechanical chest compression devices in the alpine rescue setting: a randomized triple crossover experiment

Abstract

Background Cardiopulmonary resuscitation in mountain environment is challenging. Continuous chest compressions during transport or hoist rescue are almost impossible without mechanical chest compression devices. Current evidence is predominantly based on studies conducted by urbane ambulance service. Therefore, we aimed to investigate the feasibility of continuous mechanical chest compression during alpine terrestrial transport using three different devices. Methods Randomized triple crossover prospective study in an alpine environment. Nineteen teams of the Austrian Mountain Rescue Service trained according to current ERC guidelines performed three runs each of a standardised alpine rescue-scenario, using three different devices for mechanical chest compression. Quality of CPR, hands-off-time and displacement of devices were measured. Results The primary outcome of performed work (defined as number of chest compressions x compression depth) was 66,062 mm (2832) with Corpuls CPR, 65,877 mm (6163) with Physio-Control LUCAS 3 and 40,177 mm (4396) with Schiller Easy Pulse. The difference both between LUCAS 3 and Easy Pulse (Δ 25,700; 95% confidence interval 21,118 – 30,282) and between Corpuls CPR and Easy Pulse (Δ 25,885; 23,590 – 28,181) was significant. No relevant differences were found regarding secondary outcomes. Conclusion Mechanical chest compression devices provide a viable option in the alpine setting. For two out of three devices (Corpuls CPR and LUCAS 3) we found adequate quality of CPR. Those devices also maintained a correct placement of the piston even during challenging terrestrial transport. Adequate hands-off-times and correct placement could be achieved even by less trained personnel.

Response to ‘Chest compressions at altitude are of decreased quality, require more effort and cannot reliably be self-evaluated’

“…We also concur with the assessment of a need for widespread adoption of mechanical chest compression devices in alpine settings, as those have been shown to be viable, even in difficult terrain [ 5 ].…”

Use of Mechanical Chest Compression for Resuscitation in Out-Of-Hospital Cardiac Arrest—Device Matters: A Propensity-Score-Based Match Analysis

“…Concerning Easy Pulse ® , it has a hybrid way of performing CPR, called “circulatory thoracic compression” by some authors [ 31 ]. There are two studies [ 31 , 32 ] including this device, and both of them described a lower compression depth compared to piston-driven machines.…”

“…Concerning Easy Pulse ® , it has a hybrid way of performing CPR, called “circulatory thoracic compression” by some authors [ 31 ]. There are two studies [ 31 , 32 ] including this device, and both of them described a lower compression depth compared to piston-driven machines. These two studies found a compression depth of about 35 mm, which was lower than the compression depth obtained with LUCAS ® and lower than the 50–60 mm recommended by the guidelines.…”

“…Randomized controlled trials [ 7 , 8 , 9 , 10 , 11 , 12 ], observational studies [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], and meta-analyses [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] have been carried out trying to assess the effect of these devices on the return of a spontaneous circulation (ROSC) and on OHCA patients’ survival, but they led to conflicting results. Moreover, Autopulse ® and LUCAS ® were the most studied but, once again, very little evidence is available for other devices such as EASY PULSE ® [ 31 , 32 ]. A clear and favorable effect on ROSC and survival has never been demonstrated, thus European [ 45 ] and American [ 46 ] guidelines do not recommend the routine use of these devices, which can be useful in particular settings where high quality CPR may be difficult to achieve.…”

Manual vs Mechanical Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest on a Ski Slope: A Pilot Study

“…However, many systems have adopted these devices because of ease of use, perceived benefit, and simplified maneuverability for providing CPR during transport. Prior manikin studies have evaluated the quality of mechanical CPR devices in wilderness transport settings using a Stokes basket, 10 in a sledge pulled by a snowmobile, 11 or in a helicopter, 12 and others have looked at manual CPR in a ski patrol toboggan 4 ; however, there are limited data on the quality of mechanical CPR in this setting. In a recent update to the Cochrane review, researchers did not find that using a mechanical CPR device was superior to manual CPR or consistently demonstrated either survival with good neurologic outcome or survival to hospital discharge.…”