Mechanical devices for cardiac massage: must-have or luxury? Mechanical devices for cardiac massage: must-have or luxury? Giuseppe Biondi-Zoccai, MD Sapienza University of Rome, Italy

Learning goals Why do we need mechanical devices for cardiac massage Which devices are available What are their pros What are their cons Evidence Case study

Learning goals Why do we need mechanical devices for cardiac massage Which devices are available What are their pros What are their cons Evidence Case study

The quality of manual chest compression is variable, and when low is deadly Abella et al, Circulation 2005

Manual chest compression may never be done adequately in selected settings

Learning goals Why do we need mechanical devices for cardiac massage Which devices are available What are their pros What are their cons Evidence Case study

Thumper (i.e. Life-Stat)

Vest CPR

AutoPulse

LUCAS

CardioPump ACD-CPR

Learning goals Why do we need mechanical devices for cardiac massage Which devices are available What are their pros What are their cons Evidence Case study

Obvious advantages

Reliability and force Steen et al, Resuscitation 2002

Reliability and force Cardiac arrest Manual compression LUCAS Agostoni et al, Int J Cardiol 2008

Compression and decompression Steen et al, Resuscitation 2002

Learning goals Why do we need mechanical devices for cardiac massage Which devices are available What are their pros What are their cons Evidence Case study

Trauma Larsen et al, Resuscitation 2007

Coronary pressure may be too low Larsen et al, Resuscitation 2010

Defibrillation may be delayed Putzer et al, Am J Emerg Med 2013

Learning goals Why do we need mechanical devices for cardiac massage Which devices are available What are their pros What are their cons Evidence Case study

Non-randomized trial Axelsson et al, Resuscitation 2006

RCT of AutoPulse Hallstrom et al, JAMA 2006

RCT of CardioPump ACD-CPR and ITD Aufderheide et al, Lancet 2011

Learning goals Why do we need mechanical devices for cardiac massage Which devices are available What are their pros What are their cons Evidence Case study

Age: 40 years Gender: male Comorbidities: type 1 diabetes mellitus Diagnosis: acute myocardial infarction Prehospital events/management: VF treated with DC shock, followed by PEA; manual chest compression, repeat IV adrenaline boluses, tracheal intubation, mechanical ventilation Hospital events/management: systemic thrombolysis with alteplase attempted without success; LUCAS deployment and transfer to the cath lab Biondi-Zoccai et al, HSR Proc Intensive Care Cardiovasc Anesth 2011

Baseline coronary angiography Biondi-Zoccai et al, HSR Proc Intensive Care Cardiovasc Anesth 2011

Predilation on left main-circumflex Biondi-Zoccai et al, HSR Proc Intensive Care Cardiovasc Anesth 2011

Left main-anterior descending stenting Biondi-Zoccai et al, HSR Proc Intensive Care Cardiovasc Anesth 2011

Coronary angiography after stenting Biondi-Zoccai et al, HSR Proc Intensive Care Cardiovasc Anesth 2011

Take home message Despite ongoing research for several decades, manual chest compression remains the gold standard means to perform cardiac massage. Mechanical devices have several advantages in comparison to manual chest compression. High-quality evidence is still lacking and a selected use of these devices is the safest approach until ongoing trials (e.g. CIRC, LINC and PARAMEDIC) are complete.

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