Mechanical chest compression and extracorporeal life support for out-of-hospital cardiac arrest. A 30-month observational study in the metropolitan area of Milan, Italy

Mistraletti, Giovanni; Lancioni, Armando; Bassi, Gabriele; Nespoli, Francesca; Umbrello, Michele; Salini, Silvia; Zangrillo, Alberto; Pappalardo, Federico; Scandroglio, Anna Mara; Avalli, Leonello; Patroniti, Nicolò; Raimondi, Ferdinando; Costantini, Elena; Catena, E; Ottolina, Davide; Ruffini, C.; Migliari, Maurizio; Sesana, Giovanni; Pesenti, Antonio

doi:10.1016/j.resuscitation.2022.11.025

Cited by 8 publications

(5 citation statements)

References 45 publications

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“…Conclusively, there were 24 studies shortlisted for inclusion within this systematic review and meta-analysis. [4,5,11–32] The results of the detailed screening process can be observed in the Preferred Reporting Items for Systematic Review and Meta-Analyses flowchart, illustrated in Figure 1. There were a total of 111,681 patients included in this extensive systematic review and meta-analysis, with 83,599 patients receiving manual chest compression and 28,082 patients receiving mechanical chest compression.…”

Section: Resultsmentioning

confidence: 99%

Comparison of manual chest compression versus mechanical chest compression for out-of-hospital cardiac arrest: A systematic review and meta-analysis

Larik,

Ahmed,

Shiraz

et al. 2024

Medicine

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Background: Out-of-hospital cardiac arrest is a life-threatening condition that requires immediate intervention to increase the prospect of survival. There are various ways to achieve cardiopulmonary resuscitation in such patients, either through manual chest compression or mechanical chest compression. Thus, we performed a systematic review and meta-analysis to investigate the differences between these interventions. Methods: PubMed, Cochrane Library, and Scopus were explored from inception to May 2023. Additionally, the bibliographies of relevant studies were searched. The Cochrane Risk of Bias Tool for Randomized Controlled Trials, Newcastle-Ottawa Scale, and the Risk of Bias in Non-Randomized Studies-I tools were utilized to perform quality and risk of bias assessments. Results: There were 24 studies included within this quantitative synthesis, featuring a total of 111,681 cardiac arrest patients. Overall, no statistically significant differences were observed between the return of spontaneous circulation, survival to hospital discharge, short-term survival, and long-term survival. However, manual chest compression was associated with a significantly superior favorability of neurological outcomes (OR: 1.41; 95% CI: 1.07, 1.84; P = .01). Conclusion: Although there were no major differences between the strategies, the poorer post-resuscitation neurological outcomes observed in mechanical chest compression indicate the need for further innovation and advancements within the current array of mechanical devices. However, future high-quality studies are necessary in order to arrive at a valid conclusion.

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Section: Resultsmentioning

confidence: 99%

Comparison of manual chest compression versus mechanical chest compression for out-of-hospital cardiac arrest: A systematic review and meta-analysis

Larik,

Ahmed,

Shiraz

et al. 2024

Medicine

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“…hypothermia, severe hyperkalaemia, anaphylaxis and pulmonary embolism) and resuscitation at high altitude (as cardiopulmonary resuscitation is more exhausting for the rescuer than at sea level). That said, the use of CCD will gain particular importance in the future due to the increasing establishment of extracorporeal CPR (eCPR) in specialized centres – and therefore the need to transport patients under continuous chest compression [ 24 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of teaching on use of mechanical chest compression devices: a simulation-based trial

Steffen,

Burri,

Roten

et al. 2024

Int J Emerg Med

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Background The use of mechanical chest compression devices on patients in cardiac arrest has not shown benefits in previous trials. This is surprising, given that these devices can deliver consistently high-quality chest compressions without interruption. It is possible that this discrepancy is due to the no-flow time (NFT) during the application of the device. In this study, we aimed to demonstrate a reduction in no-flow time during cardiopulmonary resuscitation (CPR) with mechanical chest compression devices following 10 min of structured training in novices. Methods 270 medical students were recruited for the study. The participants were divided as a convenience sample into two groups. Both groups were instructed in how to use the device according to the manufacturer’s specifications. The control group trained in teams of three, according to their own needs, to familiarise themselves with the device. The intervention group received 10 min of structured team training, also in teams of three. The participants then had to go through a CPR scenario in an ad-hoc team of three, in order to evaluate the training effect. Results The median NFT was 26.0 s (IQR: 20.0–30.0) in the intervention group and 37.0 s (IQR: 29.0–42.0) in the control group (p < 0.001). In a follow-up examination of the intervention group four months after the training, the NFT was 34.5 s (IQR: 24.0–45.8). This represented a significant deterioration (p = 0.015) and was at the same level as the control group immediately after training (p = 0.650). The position of the compression stamp did not differ significantly between the groups. Groups that lifted the manikin to position the backboard achieved an NFT of 35.0 s (IQR: 27.5–42.0), compared to 41.0 s (IQR: 36.5–50.5) for the groups that turned the manikin to the side (p = 0.074). Conclusions This simulation-based study demonstrated that structured training can significantly reduce the no-flow time when using mechanical resuscitation devices, even in ad-hoc teams. However, this benefit seems to be short-lived: after four months no effect could be detected.

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“…In the metropolitan area of Milan, Italy, a region of five million people with a population density of 2500 people/km 2 , 14 individuals suffers an OHCA each day. 5 , 6 Early basic life support (BLS) followed by advanced life support (ALS) are integral steps in the chain of survival. However, when conventional cardiopulmonary resuscitation (CPR) manoeuvres fail to achieve return of spontaneous circulation (ROSC) chances of survival rapidly decline.…”

Section: Introductionmentioning

confidence: 99%

“…The results of the first 30 months of this novel protocol suggested increased odds of favourable neurological outcome with the use of a mechanical CPR device, especially in patients needing prolonged resuscitation manoeuvres, and a survival rate of 9.3% in patients with refractory OHCA treated with ECPR. 5 Over the past 10 years, the pre-hospital emergency system was optimized, the equipment of ALS vehicles with mechanical CPR devices was completed, and the protocol was improved, becoming standard of care for OHCA patients.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: 10-year experience in a metropolitan cardiac arrest centre in Milan, Italy

Scquizzato,

Calabrò,

Franco

et al. 2024

Resuscitation Plus

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Mechanical chest compression and extracorporeal life support for out-of-hospital cardiac arrest. A 30-month observational study in the metropolitan area of Milan, Italy

Cited by 8 publications

References 45 publications

Comparison of manual chest compression versus mechanical chest compression for out-of-hospital cardiac arrest: A systematic review and meta-analysis

Comparison of manual chest compression versus mechanical chest compression for out-of-hospital cardiac arrest: A systematic review and meta-analysis

Impact of teaching on use of mechanical chest compression devices: a simulation-based trial

Extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: 10-year experience in a metropolitan cardiac arrest centre in Milan, Italy

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