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Objective:To analyze the factors related to the duration of chest compression pause time during the manual-mechanical conversion process in cardiopulmonary resuscitation (CRP).Methods:A retrospective study was devised in a cohort comprising patients with out-of-hospital cardiac arrest, who were assigned to receive mechanical CRP in the Department of Emergency of Huzhou First People's Hospital from January 2019 to December 2020. Patient’s general characteristics, CRP data and data on CRP-free intervals were collected multiple linear regression to analyze associations with the duration of chest compression pause time during the manual-mechanical conversion process in CRP. At the same time, the effect of CPR treatment qualification of nurses on CPR compression quality was evaluated.Results:The study selected 32 eligible patients. Patient's height, actual body weight, and body mass index showed a positive liner correlation with the duration of chest compression pause time ( r=0.61, 0.92, 0.49; P<0.01). Multiple stepwise regression analysis showed that actual body weight was an independent risk factor for prolonged duration of chest compression pause time ( P<0.01). Moreover, responsible nurses with advanced cardiac life support (ACLS) certification had significantly higher compression scores than those without ACLS certification (χ 2=0.002, P<0.01). Conclusions:The actual body weight of patients and the ACLS qualification of nurses on duty have a certain relationship with the duration of chest compression pause time during the manual-mechanical conversion process in CRP, which is worthy of further research.
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@#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.
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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.
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Objective To evaluate the influence factors of different compression modes on restoration of spontaneous circulation (ROSC) and outcomes in patients with cardiac arrest. Methods Based on the national database of emergency cardiac arrest treatment, the clinical data of 517 patients with cardiac arrest admitted to 14 teaching hospitals in 7 provinces from July 2015 to July 2017 were enrolled. According to the way of compression, the patients were divided into mechanical compression group and hands-only compression group. The demographic data, resuscitation parameters [compression frequency, monitored ventilation frequency, duration of resuscitation, drug usage] and physiological parameters [end-expiratory partial pressure of carbon dioxide (PETCO2), pulse oxygen saturation (SpO2)] were collected. The ROSC rates and 24-hour, 7-day, 28-day survival rates were compared between the two groups. Multivariate Logistic regression model was used to analyze the influencing factors of ROSC according to whether the duration of resuscitation was longer than 60 minutes. Results Of 517 patients, 24 were excluded because of incomplete data. A total of 493 patients were enrolled in the analysis with 214 patients in the mechanical compression group, and 279 in the hands-only compression group. Compared with hands-only compression group, the patients in mechanical compression group had higher age, proportion of chronic obstructive pulmonary disease (COPD) and PETCO2, fewer un-shockable rhythm, less compression rate, more epinephrine and sodium bicarbonate usage, and longer duration of cardiopulmonary resuscitation (CPR). Although the rate of ROSC in the mechanical compression group was higher than that in the hands-only compression group [36.9% (79/214) vs. 30.5% (85/279)], there was no significant difference in the rate of ROSC between the two groups [odds ratio (OR) = 1.10, 95% confidence interval (95%CI) = 0.68-1.76, P = 0.693], even after adjusted for con-variables by multivariate Logistic regression (OR = 1.21, 95%CI = 0.54-1.88, P = 0.054). Furthermore, 24-hour, 7-day, and 28-day survival rate also showed no significant difference in both univariate model and multivariate model. Comparisons of resuscitation parameters and physiological parameters between the two groups showed that when the duration of CPR < 60 minutes, the pressing frequency of the mechanical compression group was lower, ventilation frequency and adrenaline dosage were higher; and when the duration of CPR ≥ 60 minutes, the adrenaline dosage and PETCO2 of the mechanical compression group were higher. Multivariate Logistic regression analysis showed that among patients with a duration of CPR < 60 minutes, un-shockable rhythm (OR = 0.29, 95%CI = 0.05-0.75, P = 0.015), compression rate > 120 times/min (OR = 0.39, 95%CI = 0.24-0.64, P < 0.001), ventilation frequency > 40 times/min (OR = 0.50, 95%CI = 0.31-0.84, P = 0.034) were independent risk factors for ROSC; while PETCO2≥20 mmHg (1 mmHg = 0.133 kPa) was protective factor for ROSC (OR = 2.79, 95%CI = 1.88-4.49, P < 0.001). However, for patients with CPR duration ≥ 60 minutes, ≥ 65 years old (OR = 0.33, 95%CI = 0.15-0.67, P = 0.018), admission at night (OR = 0.74, 95%CI = 0.59-0.94, P = 0.035), un-shockable rhythm (OR = 0.38, 95%CI = 0.25-0.65, P = 0.001), non-cardiogenic cardiac arrest (OR = 0.35, 95%CI = 0.25-0.48, P = 0.013), previous history of diabetes mellitus (OR =0.46, 95%CI = 0.27-0.82, P = 0.015) were independent risk factors for ROSC, and cardiac arrest occurred in emergency room (OR = 2.02, 95%CI = 1.02-2.92, P = 0.023), mechanical compression (OR = 1.41, 95%CI = 1.12-1.75, P = 0.043), PETCO2≥ 20 mmHg (OR = 2.94, 95%CI = 1.34-4.54, P = 0.012), previous history of acute coronary syndrome (ACS;OR = 2.47, 95%CI = 1.15-3.78, P = 0.043) were protective factors for ROSC. Conclusions Mechanical compression CPR had no significant differences in the rate of ROSC and 24-hour, 7-day, 28-day survival rates for cardiac arrest patients in the emergency departments compared with hands-only compression CPR. For those who undergone CPR duration more than 60 minutes, mechanical compression was associated with a higher rate of ROSC.
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Objective To analyze the effect of mechanical press and manual press in cardiopulmonary resuscitation.Methods A prospective randomized controlled study was performed.A total of 95 cases who needed cardiopulmonary resuscitation were collected,according to the inclusion criteria,which including mechanical compression group (n =48),and the manual compression group (n =47).Demographic,clinical course of two groups were collected.Arterial and venous blood gas analysis in the recovery after the start of 5 minutes,15 minutes,30 minutes,the end of recovery were also collected and the pH value,partial pressure of oxygen,extracellular base remaining,actual bicarbonate,lactic acid,calcium and central venous oxygen saturation (ScvO2) and other data were mainly analyzed.All data collation and statistical analysis were used Microsoft excel,SAS 9.4.The enumeration data were expressed by the frequency and percentage,and chi square test was used.The measurement data were expressed by mean and standard deviation,and t test was used.Multiple Logistic regression analysis was performed to analysis of the effect of various factors.Results There were no statistically differences in age and pathogenic factors between the mechanical compression group and manual compression group (P ＞ 0.05).The press time,success rate of resuscitation and hospitalization days were respectively (22 ±14) minutes,81％,(37 ± 16) days in the mechanical compression group and (27 ± 19) minutes,54％,(41 ±20) days in the manual compression group,with no statistically significant differences (all P ＞ 0.05).Mechanical compression group and manual compression group were cured in 17 cases,10 cases,survived in 21 cases,9 cases,deaded in 10 cases,28 cases,with statistically significant differences between 2 groups (P ＜0.05).The troponin Ⅰ and creatine kinase MB were respectively (4.1 ± 2.0) ng/ml,(31 ± 15) U/L in the manual compression group and (5.6 ± 1.9) ng/ml,(43 ± 22) U/L in the mechanical compression group,with statistically significant differences between 2 groups (P ＜ 0.05).The defibrillation energy and defibrillation times in manual group were significantly higher than that of mechanical compression group (P ＜ 0.05).Multivariate logistic regression analysis showed that the central venous oxygen saturation at the first 5 minutes after the start of compression (x2 =65.0538,P ＜ 0.0001),the arterial blood pH at the end of compression (x2 =21.5779,P ＜ 0.0001),and the 5％ sodium bicarbonate was significantly correlated with the prognosis of survival after resuscitation,mechanical compression group was better than the manual compression group (x2 =3.1421,P =0.0463).Conclusions The effect of cardiopulmonary resuscitation machine is better than that of manual compression,which can effectively improve the clinical treatment effect.The result recommends the use of cardiopulmonary resuscitation machine for patients with cardiac arrest.
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BACKGROUND: Although modern cardiopulmonary resuscitation (CPR) substantially decreases the mortality induced by cardiac arrest, cardiac arrest still accounts for over 50％ of deaths caused by cardiovascular diseases. In this article, we address the current use of mechanical devices during CPR, and also compare the CPR quality between manual and mechanical chest compression. METHODS: We compared the quality and survival rate between manual and mechanical CPR, and then reviewed the mechanical CPR in special circumstance, such as percutaneous coronary intervention, transportation, and other fields. RESULTS: Compared with manual compression, mechanical compression can often be done correctly, and thus can compromise survival; can provide high quality chest compressions in a moving ambulance; enhance the flow of blood back to the heart via a rhythmic constriction of the veins; allow ventilation and CPR to be per formed simultaneously. CONCLUSION: Mechanical devices will be widely used in clinical practice so as to improve the quality of CPR in patients with cardiac arrest.