Shoulder strap fixation of LUCAS-2 to facilitate continuous CPR during non-supine (stair) stretcher transport of OHCAs patients

Abstract

Early recognition and rapid initiation of high-quality cardiopulmonary resuscitation (CPR) are key to maximising chances of achieving successful return of spontaneous circulation in patients with out-of-hospital cardiac arrests (OHCAs), as well as improving patient outcomes both inside and outside hospital. Mechanical chest compression devices such as the LUCAS-2 have been developed to assist rescuers in providing consistent, high-quality compressions, even during transportation. However, providing uninterrupted and effective compressions with LUCAS-2 during transportation down stairwells and in tight spaces in a non-supine position is relatively impossible. In this study, we proposed adaptations to the LUCAS-2 to allow its use during transportation down stairwells and examined its effectiveness in providing high-quality CPR to simulated OHCA patients. 20 volunteer emergency medical technicians were randomised into 10 pairs, each undergoing 2 simulation runs per experimental arm (LUCAS-2 versus control) with a loaded Resusci Anne First Aid full body manikin weighing 60 kg. Quality of CPR compressions performed was measured using the CPRmeter placed on the sternum of the manikin. The respective times taken for each phase of the simulation protocol were recorded. Fisher’s exact tests were used to analyse categorical variables and median test to analyse continuous variables. The LUCAS-2 group required a longer time (~ 35 s) to prepare the patient prior to transport (p < 0.0001) and arrive at the ambulance (p < 0.0001) compared to the control group. The CPR quality in terms of depth and rate for the overall resuscitation period did not differ significantly between the LUCAS-2 group and control group, though there was a reduction in both parameters when evaluating the device’s automated compressions during transport. Nevertheless, the application of the LUCAS-2 device yielded a significantly higher chest compression fraction of 0.76 (p < 0.0001). Our novel adaptations to the LUCAS-2 device allow for uninterrupted compressions in patients being transported down stairwells, thus yielding better chest compression fractions for the overall resuscitation period. Whether potentially improved post-OHCA survival rates may be achieved requires confirmation in a real-world scenario study.

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 .…”

“…There were seven studies, all manikin trials, which suggested that higher floors compromised CPR quality. Bekgoz et al and Chen et al reported poorer CPR quality (measured in terms of lower chest compression fractions) with manual compared to mechanical chest compressions when manual compressions were administered to the manikins during transport from the third to first floor [ 11 , 15 ]. Drinhaus et al similarly reported a significantly lower proportion of good-quality compressions with adequate rate when manual compressions were performed en-route via a lift, turntable ladder, or staircase [ 21 ].…”

“…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 ].…”

Shock Index Is a Validated Prediction Tool for the Short-Term Survival of Advanced Cancer Patients Presenting to the Emergency Department

“…This study is part of a series by the Stratification to Prevent Overcrowding Taskforce (SPOT) investigators, a research group dedicated to maximising clinical outcomes right from the ED via rapid and accurate identification of patients requiring urgent intervention, with the secondary objective of alleviating ED overcrowding. We have to date studied several risk stratification tools in intra-abdominal infections [ 31 , 32 , 33 , 34 , 35 , 36 ], snakebites [ 37 ], and now advanced cancer [ 18 ], amongst others [ 38 , 39 ].…”

What are ambulance crews’ experiences of using a mechanical chest compression device for out-of-hospital resuscitation? A constructivist qualitative study utilising online focus groups

“…This is further supported by the most recent Cochrane review on MCCDs, which acknowledges that they could be an alternative when high-quality manual compressions are not possible or are dangerous ( Wang & Brooks, 2018 ). Previous work has investigated the specific uses of MCCDs in the pre-hospital environment, such as providing high-quality cardiopulmonary resuscitation (CPR) while extricating ( Chen et al, 2021 ; Lyon et al, 2015 ) and transporting a patient from scene to the hospital ( Fox et al, 2013 ). Based on these benefits, such devices are still used by some systems, including North East Ambulance Service, which encompasses both urban and rural regions and serves a population of almost three million people ( North East Ambulance Service NHS Foundation Trust, 2018 ).…”