Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial

Out-of-hospital airway management during manual compression or automated chest compression devices

“…The use of ACCD during CPR of OHCA patients may to be associated with some advantages: minimization of interruptions, constant compression depth and high compression ratio. Despite the fact that the three major randomized controlled trials on the use of ACCD (CIRC [6], LINC [7] and PARAMEDIC [8]) did not show a benefit of ACCD over mCC in OHCA, no profound risks or evidence of inferiority of ACCD in comparison to mCC were found. These previous findings were not in line with the findings of the presented GRR study showing that the outcomes of OHCA patients who received mCC were significantly better in comparison to patients who received ACCD.…”

“…It can be hypothesized that SAD was not so effective for securing the airway during CPR as expected and that SAD should be perceived as an unsecured airway. Thus, it is conceivable that the results of the three major ACCD trials (CIRC [6], LINC [7] and PARAMEDIC [8]) may reveal a significant difference between the study arms if patients ventilated with a bag-valve mask or SAD were excluded from the analysis. We presume that, particularly with SAD and continuous ACCD, ventilation is ineffective and a significant confounder in the three mentioned major ACCD studies.…”

“…In Europe, there has also been an increase in the use of ACCD. The three major randomized controlled trials on the use of ACCD, the CIRC [6], LINC [7] and PARAMEDIC [8] trials and other [9] did not show a benefit of ACCD over manual chest compression (mCC) in OHCA; however, they also did not reveal any profound risks or evidence of inferiority of ACCD; therefore, problems with the use of ACCD have significant implications for patient safety and are of major interest for the scientific community [10]. Data and recommendations concerning airway strategy and the compression to ventilation ratio during ACCD use on outcome of OHCA are missing [10].…”

What is new in the 2015 American Heart Association guidelines, what is recycled from 2010, and what is relevant for emergency medicine in Canada

“…16,17 Conventional manual chest compressions remain the standard of care for the treatment of cardiac arrest, but mechanical chest compression devices may be a reasonable alternative for use by properly trained personnel. [18][19][20] When rapidly implemented, extracorporeal cardiopulmonary resuscitation (ECPR) can prolong viability for patients who are not resuscitated with conventional CPR. ECPR can provide time to treat potentially reversible conditions or arrange cardiac transplantation.…”

The impact of prehospital resuscitation research on in-hospital care

“…5 It is intuitive that mechanical devices should provide superior CPR quality compared to human rescuers as length of resuscitation increases, particularly when the number of available rescuers is limited. Recent randomized controlled trials regarding the effectiveness of different mechanical CPR devices on neurologically intact survival after cardiac arrest have shown similar CPR quality metrics when compared to manual CPR [21][22][23] but no improvements in clinical outcomes. Some EMS systems have adopted the view that mechanical CPR devices improve paramedic safety while transporting victims of cardiac arrest to the hospital.…”