1. 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 giuseppe.biondizoccai@uniroma1.it

2. 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

3. 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

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

5. Manual chest compression may never be done adequately in selected settings

6. 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

7. Thumper (i.e. Life-Stat)

8. Vest CPR

9. AutoPulse

11. LUCAS

13. CardioPump ACD-CPR

15. 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

16. Obvious advantages

17. Reliability and force Steen et al, Resuscitation 2002

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

19. Compression and decompression Steen et al, Resuscitation 2002

20. 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

21. Trauma Larsen et al, Resuscitation 2007

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

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

24. 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

25. Non-randomized trial Axelsson et al, Resuscitation 2006

26. RCT of AutoPulse Hallstrom et al, JAMA 2006

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

28. 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

29. 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

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

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

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

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

34. 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.

35. Many thanks for your attention For these slides and further ones on similar topics feel free to visit: www.metcardio.org/slides.html For additional details or queries feel free to contact me directly: giuseppe.biondizoccai@uniroma1.it