The Effect of a Mechanical Compression Device and Supraglottic Airway on Flow Time: A Simulation Study of Out-of-Hospital Cardiac Arrest in a High-Rise Building

Abstract

High-rise buildings present unique challenges to providing high-quality CPR. We investigated the effect of using a mechanical compressor and supraglottic airway on flow time and CPR quality in simulated cardiac arrests occurring within a high-rise building. Twelve teams of EMS providers performed CPR according to 4 scenarios: manual compression and ventilation through bag-valve-mask (MAB) or supraglottic airway (MAS); mechanical compression and ventilation through bag-valve-mask (MEB) or supraglottic airway (MES). Chest compression indices did not differ significantly among the groups. The mechanical compression groups had a higher flow time fraction from exiting the elevator until the manikin was loaded into the ambulance than the manual compression groups. The supraglottic airway groups had higher flow time fractions from entering the elevator until the end of the scenario than the bag-valve-mask groups. The total flow time fraction was lowest in the MAB group and was highest in the MEB group (P < 0.001). In simulated cardiac arrest in a high-rise building, the use of a supraglottic airway maintained flow time at a level similar to that observed with the use of a mechanical compressor. Moreover, the use of a mechanical compressor and a supraglottic airway increased the flow time most effectively.

Cardiac Arrest Occurring in High-Rise Buildings: A Scoping Review

“…A further seven articles were removed after review of full texts. Finally, 23 articles were included in the scoping review [ 4 , 5 , 6 , 7 , 8 , 11 , 12 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. The characteristics of included studies are summarised in Table 1 .…”

“…Given the poorer outcomes of OHCA patients from high-rise settings and poorer quality of prehospital interventions, some studies have attempted to look at solutions to address these issues. Six manikin trials compared the use of mechanical CPR (mCPR) with manual compressions during scenario-based resuscitative procedures in high-rise settings [ 11 , 12 , 15 , 21 , 23 , 28 ]. Four of these trials reported positive findings for mCPR where its use led to higher chest compression fractions and greater proportions of guideline-compliant chest compression rate and depth [ 11 , 12 , 15 , 21 ].…”

“…However, contemporary guidelines for resuscitation and EMS protocols lack specific recommendations for EMS systems and practitioners regarding their approach to patients in cardiac arrest in high-rise buildings. Furthermore, definitions and standards on the classification of high-rise buildings used in the literature are heterogenous, ranging from 3-storey apartment buildings without elevators [ 11 ] to those with more than 30 storeys and with elevator access to every floor [ 12 ].…”