Clinical effectiveness of a pneumatic compression device combined with low-molecular-weight heparin for the prevention of deep vein thrombosis in trauma patients: A single-center retrospective cohort study / 世界急诊医学杂志（英文）

@#BACKGROUND: To investigate the clinical effectiveness of a pneumatic compression device (PCD) combined with low-molecular-weight heparin (LMWH) for the prevention and treatment of deep vein thrombosis (DVT) in trauma patients. METHODS: This study retrospectively analyzed 286 patients with mild craniocerebral injury and clavicular fractures admitted to our department from January 2016 to February 2020. Patients treated with only LMWH served as the control group, and patients treated with a PCD combined with LMWH as the observation group. The incidence of DVT, postoperative changes in the visual analogue scale (VAS) score, and coagulation function were observed and compared between the two groups. Excluding the influence of other single factors, binary logistic regression analysis was used to evaluate the use of a PCD in the patient's postoperative coagulation function. RESULTS: After excluding 34 patients who did not meet the inclusion criteria, 252 patients were were included. The incidence of DVT in the observation group was significantly lower than that in the control group (5.6% vs. 15.1%, χ2=4.605, P<0.05). The postoperative VAS scores of the two groups were lower than those before surgery (P<0.05). The coagulation function of the observation group was significantly higher than that of the control group, with a better combined anticoagulant effect (P<0.05). There were no significant differences between the two groups in preoperative or postoperative Glasgow Coma Scale scores, intraoperative blood loss, postoperative infection rate, or length of hospital stay (P>0.05). According to logistic regression analysis, the postoperative risk of DVT in patients who received LMWH alone was 1.764 times that of patients who received LMWH+PCD (P<0.05). The area under the receiver operating characteristic (AUROC) curve of partial thromboplastin time (APTT) and platelet (PLT) were greater than 0.5, indicating that they were the influence indicators of adding PCD to prevent DVT. Excluding the influence of other variables, LMWH+PCD effectively improved the coagulation function of patients. CONCLUSIONS: Compared with LMWH alone, LMWH+PCD could improve blood rheology and coagulation function in patients with traumatic brain injury and clavicular fracture, reduce the incidence of DVT, shorten the length of hospital stay, and improve the clinical effectiveness of treatment.

Simulation study on quality of CPR between manual chest compression and mechanical chest compression devices performed in ambulance

@#Background: Maintaining good quality CPR while transporting out-of-hospital cardiac arrest patients is very challenging. We aim to determine how different ambulance speed can affect the quality of chest compression performed either manually or mechanically. Methods: This was an observational manikin-based study. A total of 96 participants as well as two types of mechanical compression devices: Lucas-2 and AutoPulse, performed one minute of continuous chest compression on BT-CPEA programmed manikin while the ambulance travelled at different speeds, i.e., idle state, 30km/hr and 60km/hr. Seven outcome variables of chest compression were measured. Performance data of different groups of compressor were compared and analysed using repeated measures analysis of variance (ANOVA). Results: In manual chest compression, significant variation were noted among different speeds in term of average compression rate (p<0.001), average compression depth (p=0.007), fraction of adequate/insufficient compression depth and fraction of normal hands positioning with p=0.018, 0.022 and 0.034 respectively. Overall, AutoPulse and Lucas-2 were not affected by ambulance speed. Lucas2 showed more consistent average compression rate, higher fraction of adequate compression depth and reduced fraction of insufficient compression depth as compared to manual compression with p<0.001, 0.001 and 0.043 respectively. Conclusion: In this study we found that ambulance speed significantly affected certain aspects of manual chest compression most notably compression depth, rate and hand positioning. AutoPulse and Lucas-2 can improve these aspects by providing more consistent compression rate, depth and fraction of adequate compression depth during transport.

Design and application of rescue stretcher dedicated for cardiopulmonary resuscitation mechanical compression device / 中华危重病急救医学

Continuous chest compressions during the transportation of patients with cardiac arrest have always been a difficult part in the field of pre-hospital emergency cardiopulmonary resuscitation (CPR). How to ensure continuous high-quality chest compressions is an important part of the patient's entire rescue process. At present, mechanical compression devices are commonly used to provide continuous high-quality chest compressions during the transportation. However, the installation process of the mechanical compression device involves posture changes of the patient, the placement of the device base, etc., and it is very likely to affect the continuous high-quality CPR treatment in the pre-hospital emergency process with limited human resources. Therefore, the First Affiliated Hospital of Huzhou University and Huzhou University jointly designed a rescue stretcher dedicated for CPR mechanical compression device, and has obtained the national utility model patent (ZL 2019 2 1005444.9). The main design feature of this stretcher is that the base of the compression device is combined with the stretcher, which eliminates the installation and fixation process of the base during the installation of the mechanical compression device, shortens the installation time. It has certain clinical applications value.

Effect analysis of abdominal compression-decompression device in patients with cardiopulmonary resuscitation in pre-hospital first aid / 中华危重病急救医学

Objective To investigate the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) in patients with pre-hospital respiratory and cardiac arrest.Methods Forty-five patients with respiratory and cardiac arrest,and with contraindication of chest compression admitted to Baiyin Central Hospital of Gansu Province from March 2012 to September 2018 were enrolled,and they were divided into two groups according to random number table.AACD-CPR (abdominal compression-decompression group,n =24) and cardiopulmonary resuscitation (CPR) with unarmed abdominal compression (unarmed abdominal pressure group,n =21) were performed respectively.The success rate of rescue was observed in the two groups,and the changes in heart rate (HR),pulse oxygen saturation (SpO2) and blood pressure 30 minutes after CPR in patients with restoration of spontaneous circulation (ROSC) were observed.Results Among the 24 patients in the abdominal compression-decompression group,5 patients (20.83％) had ROSC,and 2 patients (9.52％) had ROSC in 21 patients of the unarmed abdominal pressure group.The success rate of resuscitation in the abdominal compression-decompression group was significantly higher than that in the unarmed abdominal pressure group (P ＜ 0.05).HR of ROSC patients at 30 minutes of CPR in abdominal compression-decompression group was significantly lower than that in unarmed abdominal compression group (bpm:139.45±5.08 vs.147.62±5.24,P ＜ 0.05),and SpO2 and blood pressure were significantly higher than those in unarmed abdominal compression group with significant differences [SpO2:0.92 ± 0.03 vs.0.85 ± 0.03,systolic blood pressure (SBP,mmHg,1 mmHg =0.133 kPa):118.23 ± 3.26 vs.98.51 ± 3.10,diastolic blood pressure (DBP,mmHg):60.10 ± 2.50 vs.56.36 ± 2.45,all P ＜ 0.05].Conclusion The effect of AACD-CPR was superior to that of unarmed abdominal pressure CPR,which had higher application value to rescue patients with respiratory and cardiac arrest with chest pressure contraindication.

Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome / Uso da terapia compressiva ou não compressiva na trombose venosa profunda e síndrome pós-trombótica: dois caminhos divergentes

Abstract Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the "valve mechanism" generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

Resumo O uso da terapia de compressão para reduzir a incidência de síndrome pós-trombótica em pacientes com trombose venosa profunda apresenta controvérsias como o uso da compressão elástica versus inelástica, os níveis e a duração da compressão. Dispositivos inelásticos com índice de rigidez estática combinam uma pressão pequena e confortável em repouso com uma pressão forte o suficiente para restaurar o "mecanismo de válvula" gerado pela flexão plantar e dorsiflexão do pé. Uma vez que o índice de rigidez estática depende da rigidez do sistema de compressão e da força muscular dentro da área enfaixada, a melhoria da massa muscular com programas de fortalecimento e treinamento de resistência deve ser incentivada. Na fase aguda dos eventos de trombose venosa profunda, a anticoagulação acompanhada de terapia de compressão inelástica pode reduzir a extensão do trombo. Assim, são necessários estudos que avaliem a eficácia da terapia inelástica na trombose venosa profunda e na síndrome pós-trombótica.

Comparison of Outcomes between AutoPulse(TM) and Manual Compression in Out-of-hospital Cardiac Arrest Patient

PURPOSE: This study compared the outcomes of AutoPulseTM compression with manual compression provided by 119 paramedics in out-of-hospital cardiac arrest patients. METHODS: Between March and December 2016, a total of 221 out-of-hospital cardiac arrest patients were included for analysis. The patients included were categorized as the AutoPulseTM compression group and manual compression group. Patient's age, sex, pre-hospital intubation, bystander cardiopulmonary resuscitation (CPR), initial cardiac rhythm, time from arrest to CPR and CPR duration were reviewed retrospectively. The initial pH, lactate level, white blood cell (WBC) count, delta neutrophil index (DNI), and targeted temperature management status were collected. As clinical outcomes, the return of spontaneous circulation (ROSC), hospital and intensive care unit (ICU) length of stay, survival rate, and cerebral performance category (CPC) scale at discharge were analyzed. RESULTS: The initial rhythm and CPR duration were similar in the two groups. On the other hand, the pre-hospital intubation rate and pre-hospital CPR duration were significantly higher in the AutoPulseTM group than the manual group (32.9% vs. 12.7%, p < 0.001; 15.2 vs. 11.9 minutes, p=0.002). The ROSC rate, hospital and ICU length of stay, CPC scale and survival rate at discharge as the clinical outcome were similar in the AutoPulseTM group and manual group. The pH was lower and the lactate level was significantly higher in the AutoPulseTM group than the manual group (6.91 vs. 6.96, p=0.007; 12.8 vs. 11.4 mmol/L, p=0.031), but the WBC and DNI were similar in the two groups. CONCLUSION: The use of AutoPulseTM provided by 119 paramedics in out-of-hospital cardiac arrest patients is not associated with better clinical outcomes.

Incidences of Deep Vein Thrombosis and Pulmonary Embolism after Total Knee Arthroplasty Using a Mechanical Compression Device with and without Low-Molecular-Weight Heparin

PURPOSE: To investigate the incidence of thromboembolic events and complications related to bleeding after total knee arthroplasty (TKA) with a mechanical compression device alone or in combination with low-molecular-weight heparin (LMWH). MATERIALS AND METHODS: A total of 489 TKA patients (776 knees) were retrospectively reviewed for the incidence of thromboembolic events and complications related to bleeding. While 233 patients (354 knees) were treated with a mechanical compressive device without LMWH, 256 patients (422 knees) were treated with the mechanical compressive device along with LMWH. RESULTS: The incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) were 15 of 375 knees (4.0%) and 5 of 375 knees (1.3%), respectively, in the group that used only a mechanical compressive device, and 14 of 401 knees (3.4%) and 5 of 401 knees (1.2%), respectively, in the group that used the mechanical compressive device with LMWH. There was no significant difference between the two groups (p=0.125 and p=0.146, respectively). The postoperative hemovac drainage amount was 635±57 mL in the group with a mechanical compressive device only and 813±84 mL in the group with the device and LMWH; therefore, the amount of drainage was significantly greater in the latter group (p=0.013). CONCLUSIONS: Mechanical compression alone for prophylaxis against DVT and PE after TKA can be an attractive option in Korean patients.

Comparison of Clinical and Physiological Efficacies of Different Intermittent Sequential Pneumatic Compression Devices in Preventing Deep Vein Thrombosis: A Prospective Randomized Study

BACKGROUND: There are few comparative studies about the optimal method of pneumatic compression to prevent deep vein thrombosis (DVT). The aim of this prospective randomized study was to compare venous hemodynamic changes and their clinical influences between two graded sequential compression groups (an alternate sequential compression device [ASCD] vs. a simultaneous sequential compression device [SSCD]). METHODS: In total, 34 patients (68 limbs) undergoing knee and spine operations were prospectively randomized into two device groups (ASCD vs. SSCD groups). Duplex ultrasonography examinations were performed on the 4th and 7th postoperative days for the detection of DVT and the evaluation of venous hemodynamics. Continuous data for the two groups were analyzed using a two-tailed, unpaired t-test. Relative frequencies of unpaired samples were compared using Fisher exact test. Mixed effects models that might be viewed as ANCOVA models were also considered. RESULTS: DVT developed in 7 patients (20.6%), all of whom were asymptomatic for isolated calf DVTs. Two of these patients were from the ASCD group (11.8%) and the other five were from the SSCD group (29.4%), but there was no significant difference (p = 0.331). Baseline peak velocity, mean velocity, peak volume flow, and total volume flow were enhanced significantly in both device groups (p < 0.001). However, the degrees of flow and velocity enhancement did not differ significantly between the groups. The accumulated expelled volumes for an hour were in favor of the ASCD group. CONCLUSIONS: Both graded sequential compression devices showed similar results both in clinical and physiological efficacies. Further studies are required to investigate the optimal intermittent pneumatic compression method for enhanced hemodynamic efficacy and better thromboprophylaxis.

Extensive Bullous Complication Associated with Intermittent Pneumatic Compression

Intermittent pneumatic compression (IPC) device is an effective method to prevent deep vein thrombosis. This method has been known to be safe with very low rate of complications compared to medical thromboprophylaxis. Therefore, this modality has been used widely in patients who underwent a hip fracture surgery. We report a patient who developed extensive bullae, a potentially serious skin complication, beneath the leg sleeves during the use of IPC device after hip fracture surgery.

The effects of intermittent pneumatic compression device on body temperature during propofol-remifentanil anesthesia: A comparison with elastic stockings

BACKGROUND: We hypothesized that intermittent pneumatic compression device (IPCD) compression system might induce more decreases on the core temperature by increasing the lower extremity blood flow. This study investigated the effects of IPCD compression system on the body temperature in patients undergoing minor surgery under propofol-remifentanil anesthesia. METHODS: Forty female patients were randomly assigned to treat with either elastic stockings (ES group, n = 20) or IPCD (IPCD group, n = 20). Anesthesia was induced and maintained with propofol and remifentanil. The core temperature and arteriovenous shunt in the lower leg were measured using esophageal temperature and the calf to toe skin-surface temperature gradient, respectively. The measurements were taken at 15-minute intervals immediately after anesthesia induction (baseline values, T0) until the end of the surgery. RESULTS: During the study period, the core temperature and skin temperature gradient were comparable between the two groups. The core temperature decreased from 60 min in both groups. And, skin-surface temperature gradient decreased from 15 min in the IPCD group and 30 min in the ES group after anesthesia induction, without intergroup differences across time. CONCLUSIONS: This study demonstrated that the IPCD system did not affect the change in the core temperature when compared to the ES, in patients undergoing minor surgery during propofolremifentanil anesthesia. Thus, the IPCD system could be safely used during propofol-remifentanil anesthesia, without increasing the risk of the intraoperative hypothermia.

Comparison of the hemostatic time of the radial hemostatic compression device after transradial coronary intervention / 中国实用护理杂志

Objective To investigate the hemostatic effect of the radial hemostatic compression device(TR Band hemostatic gasbag)after transradial coronary intervention and discuss the optimal hemostasis time.Methods 266 patients who received transradial coronary angiography and used TR Band hemostatic gasbag for hemostasis were divided into group A,B and C,according to the compression time,the compression time in group A (90 cases)was 8 h,10 h in group B (87cases),12 h in group C (89 cases).The condition of bleeding,changes in blood oxygen saturation,and hand swelling in each group were compared.Results The bleeding rates of group A,B and C were respectively 16.7％,3.4％ and 9.0％,the difference was statistically significant.The incidence of hand swelling after operation in group A,B and C were respectively 27.8％,12.6％ and 21.3％,the difference was statistically significant.No significant difference was seen in blood oxygen saturation between three groups.Conclusions Application of radial hemostatic compression device after transradial coronary intervention proved good hemostasis effect,compression time for 10 h has the best effect and less adverse effect.

The Efficacy of the Change in Belly Board Aperture Location by the Addition of Bladder Compression Device for Radiotherapy of Rectal Cancer / 대한방사선종양학회지

PURPOSE: We investigated the effect of location changes in the inferior border of the belly board (BB) aperture by adding a bladder compression device (BCD). MATERIALS AND METHODS: We respectively reviewed data from 10 rectal cancer patients with a median age 64 years (range, 45~75) and who underwent computed tomography (CT) simulation with the use of BB to receive pelvic radiotherapy between May and September 2010. A CT simulation was again performed with the addition of BCD since small bowel (SB) within the irradiated volume limited boost irradiation of 5.4 Gy using the cone down technique after 45 Gy. The addition of BCD made the inferior border of BB move from symphysis pubis to the lumbosacral junction (LSJ). RESULTS: Following the addition of BCD, the irradiated volumes of SB and the abdominopelvic cavity (APC) significantly decreased (174.3+/-89.5 mL vs. 373.3+/-145.0 mL, p=0.001, 1282.6+/-218.7 mL vs. 1571.9+/-158 mL, p<0.001, respectively). Bladder volume within the treated volume increased with BCD (222.9+/-117.9 mL vs. 153.7+/-95.5 mL, p<0.001). The ratio of irradiated bladder volume to APC volume with BCD (33.5+/-14.7%) increased considerably compared to patients without a BCD (27.5+/-13.1%) (p<0.001), and the ratio of irradiated SB to APC volume decreased significantly with BCD (13.9+/-7.6% vs. 24.2+/-10.2%, p<0.001). The ratios of the irradiated SB volumeand irradiated bladder volume to APC volume negatively correlated (p=0.001). CONCLUSION: This study demonstrated that the addition of BCD, which made the inferior border of BB move up to the LSJ, increased the ratio of the bladder to APC volume and as a result, decreased the irradiated volume of SB.

Comparison of CPR Outcomes between Autopulse TM and Manual Compression in Adult Out-of-hospital Cardiac Arrest

PURPOSE: Our goal was to compare resuscitation outcomes, 24 hour survival, and survival discharge between patients resuscitated with an AutoPulse compression device vs. those resuscitated using manual compression in adult, out-of-hospital non-traumatic cardiac arrest patients. METHODS:We retrospectively reviewed cases of out-of-hospital cardiac arrest that occurred between July 2005 and June 2008. We included, 267 non-traumatic patients who had. We compared characteristics between 93 patients who had AutoPulse compression and 174 patients who had manual compression. Characteristics included resuscitation outcomes (return of spontaneous circulation [ROSC], 24 hour survival and resuscitation outcomes according to the initial ECG. RESULTS: The rate of ROSC was 43.1% for AutoPulse compression and 50.57% for manual compression; the difference was not significant (p=0.294). Survival rates at 24 hours were, respectively, 33.3% and 31.6% (p=0.88). Survival discharge proportions were, 8.6% and 11.5%, respectively (p=0.599). CONCLUSION: There are no statistically significant differences in resuscitation outcomes between AutoPulse and manual compression in adult, out-of-hospital, non-traumatic, cardiac arrest patients.

The Effect of SCD Response Compression System on Coagulation and Fibrinolysis using Thromboelastography in Patients Undergoing Gastrectomy; a Comparison with Elastic Stocking / 대한마취과학회지

BACKGROUND: Among various measures to prevent deep venous thrombosis (DVT) in surgical patients, intermittent pneumatic compression of the legs is known to be effective without increasing the risk of bleeding. In this study, the coagulation/ fibrinolysis profile in patients undergoing gastrectomy with SCD Response Compression System, which detects individual venous refill time, was compared to that with elastic stocking using thromboelastography (TEG). METHODS: Fifty-eight ASA class I-II patients undergoing gastrectomy were randomized into two groups. Patients in ES group (n = 29) were treated with elastic stocking and patients in SCD group (n = 29) were treated with SCD Response Compression System. TEG analysis and traditional coagulation tests were performed on arrival in the operating room, after surgery in the postanesthetic care unit and on the morning of postoperative day 1. RESULTS: There was no significant difference in laboratory data between the two groups. Laboratory data at all time points were within normal limit in all patients. There was no significant difference in TEG data between the two groups. No evidence of a postoperative clinical coagulopathy (DVT or pulmonary embolism) was observed on routine history and physical examinations in any patient during hospitalization. CONCLUSIONS: The effectiveness of SCD Response Compression System in patients undergoing major abdominal surgery on coagulation/fibrinolysis system was similar to that of elastic stocking during perioperative period.

Rabbit model of intervertebral disc degeneration by external compression device characterized by X-ray, MRI, histology, and cell viability.

Appropriate experimental animal models, which mimic the degenerative process occurring in human intervertebral disc (IVD) breakdown and can be used for new treatment studies such as tissue engineering or disc distraction are lacking. We studied the external compression device that used by Kroeber et al to create intervertebral disc degeneration in rabbit model characterized by X-ray, MRI, Histology, and Cell Viability. Ten NZW rabbit were randomly assigned to one of five groups. Intervertebral disc VL4-L5 are compressed using an external loading device, 1.9 MPa. First group rabbit are loaded for 14 days, second loaded for 28 days, thirth group are loaded for 14 days, and unloaded for 14 days, fourth group loaded for 28 days and unloaded for 28 days. The fifth group, rabbits underwent a sham operation. Additional, rabbits were used as sample for cell viability study. In disc height : sample in group one have biggest decreasing of disc height, that is 23.9 unit. In MRI assessment, the worst grade is grade 3. In histological score, the worst group is group three (58.69), and the best is group 4 (45.69). Group one have the largest dead cell, that are 403.5, and the smallest is group four (124.75). Trypan blue staining showed that group four have better viable cell (91.1) compare than group three (86.4). The study conclude disc degeneration can be created by external axial loading for 14 days in rabbit intervertebral disc. Duration of 28 days unloading gave better result for cells to recover.

Treatment of Hypertrophic Scar on Earlobe using Magnetics

Ear piercing is one of the most frequently performed esthetic operations. However, complications of this procedure such as getting an infection, a foreign body within the wound, can lead to excessive tension which may develop into a hypertrophic scar. Treatment of a hypertrophic scar needs compression but it is difficult to do so with the earlobe. To be effective, a compression device must be uniformed, adjustable, easy to apply, removeable, clean, made from an inert material, light in weight, inexpensive, easy to make, and cosmetically acceptable. We have experienced 47 patients with hypertrophic scars on their earlobes complicated from ear piercing. We thought that using magnetic discs would be the best method for this problem; we were right. Ever since, we have been using magnetic discs for the treatment of hypertrophic scars on earlobes and the results have been satisfying.