Automatic and manual devices for cardiopulmonary resuscitation: A review

Abstract

Rate of survival without any neurological consequence after cardiac arrest is driven not only by early recognition but also by high-quality cardiopulmonary resuscitation. Because the effectiveness of the manual cardiopulmonary resuscitation is usually impaired by rescuers' fatigue, devices have been devised to improve it by appliances or ergonomic solutions. However, some devices are thought to replace the manual resuscitation altogether, either mimicking its action or generating hemodynamic effects with working principles which are entirely different. This article reviews such devices, both manual and automatic. They are mainly classified by actuation method, applied force, working space, and positioning time. Most of the trials and meta-analyses have not demonstrated that chest compressions given with automatic devices are more effective than those given manually. However, advances in clinical research and technology, with an improved understanding of the organizational implications of their use, are constantly improving the effectiveness of such devices.

Estimation of the variations in mechanical impedance between the actuator and the chest, and the power delivered to the chest during cardiopulmonary resuscitation using machine-embedded sensors

“…Such capabilities are not available in most of the currently commercialized CPR machines. For example, Lucas-II™ (Physio-Control Inc., Lund, Sweden) compresses the center of chest for CPR, but several reports commented side-effects of the device when the position of compression is inappropriate [ 3 , 6 , 13 , 26 , 27 ]; and AutoPulse™ (Zoll Medical Corp., Chelmsford, USA) compresses overall chest area for CPR, but several reports commented the risk of damage in other organs during CPR process [ 2 , 3 , 7 , 26 , 27 ]. If the currently proposed real-time MI and power estimation algorithm is applied to the control of the CPR machine and more dedicated safety functions, as described above, are realized later, complications related to the CPR machine can be reduced because the MI variations would reflect the variations in chest features such as thoracic skeleton, ligaments, and connected muscles, and the movements of the heart, lungs, and other organs during the CPR process.…”

“…When such an emergency situation occurs in locations outside of a hospital due to accidents or disease, emergency services should be immediately contacted and manual CPR process needs to be performed repetitively until the arrival of the trained paramedics. The paramedics then consistently perform emergency rescue processes using an automated external defibrillator and a CPR machine while transporting the patient to the hospital [ 2 , 3 ]. The CPR machine delivers repetitively short and strong pressing action to the patient’s chest via an actuator.…”

“…In addition, when the CPR position is changed during the process due to the wobble or vibration of the ambulance while transporting, the efficacy of the CPR process deteriorates and additional harm to the patient can occur [ 6 ]. To reduce such risk of patient harm, it is necessary to consistently monitor the status of patient and the quality of CPR during the operation of the CPR machine [ 3 ].…”

“…The most representative method for this purpose, recommended by the American Heart Association (AHA), is capnography. Capnography measures the end-tidal carbon dioxide (ETCO 2 ) through endotracheal intubation, which is closely related to myocardial blood flow [ 3 , 7 ]; however, its application in emergency situations is limited due to the risk of the improper insertion of an intubation tube and accidental displacement of the tube during transport [ 8 , 9 ]. Currently, some of the automated external defibrillators utilize the electrocardiogram (ECG) signals of the patient to determine the need for further electric shock.…”

Special Collection on advances in rehabilitation engineering with robotics and mechatronic devices

“…In the paper ''Automatic and manual devices for cardiopulmonary resuscitation: A review,'' 12 an analysis of the current technology of cardiopulmonary resuscitation (CPR) systems is proposed. Firstly, the devices are classified by actuation method, applied force, working space, and positioning time.…”