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Table of Contents

I. Introduction
II. Statement of the Problem
Main Problem
Secondary Problems
III. Evidences
IV. Synthesis
Strength
Weaknesses
Answer to the Problem
V. Conclusion
VI. Recommendation
VII. Appendices
References
Curriculum Vitae

I. Introduction
Sudden Cardiac Arrest is like a thief in the night, it strikes without warning. It is a
condition that contributes to significant mortality in the adult population, with major and
catastrophic psychological and emotional effects on the family. Unlike the usual chronic
diseases that contribute to mortality and morbidity, sudden cardiac arrest is an
unpredictable condition.
Today, it is said to be the single largest categorical cause of death in the United
States and around the world according to World Health Organization (WHO). In 2012,
the disease killed 17. 5 million people, that is 3 in every 10 deaths. In Philippines, heart
disease is the common cause of death among adults with a 20% rate of deaths
according to the recent statistics of the Department of Health in 2012, it is not a surprise
if cardiac arrest condition to the high incidence of death particularly cardiac arrest.
Sudden Cardiac Arrest remains a major public health problem. It is associated
with low survival rate, and major long term severe mental impairment due to delays in
cardiopulmonary resuscitation (CPR) and treatment.
In order to be able to save the lives of sudden cardiac arrest patients and avoid
neurological damage, a steady supply of oxygen to the heart and brain is necessitated.
Life-sustaining circulation can be created through effective and uninterrupted chest
compressions. As initial response to Cardiac Arrest patients, Cardio Pulmonary
Resuscitation is the primary intervention in able to provide circulation to the vital organs
of the body and to avoid organ failure which leads to death. Performing manual chest

compressions of high quality is both difficult and tiring, and impossible in certain
situations.
To address the low survival rate among cardiac arrest patients, and with the new
advances in the technology, Automated Chest Compression device which automatically
do chest compression was invented and readily made available in an emergency
situation, specifically Cardiac Arrest.
Our main objective is to determine the effectivity of the Automated Chest
Compression Device in responding to emergency situation, specifically cardiac arrest
patients, and compare it to Manual Chest Compressions. Our secondary objective is to
determine the advantage, safety and reliability of the ACCD.

II. Statement of the Problem


Main Problem:
1. Is Automated Chest Compression Device effective in responding to Cardiac Arrest
patients as compared to Manual Chest Compression?
Secondary Problems:
2. What are the advantages of using Automated Chest Compression Device on nurses
and other health care providers?
3. Is Automated Chest Compression Device safe and reliable?

III. Evidences
1. Continuous mechanical chest compression during in-hospital cardiopulmonary
resuscitation of patients with pulseless electrical activity (Bonnemeier, 2011)
Introduction: Survival after in-hospital pulseless electrical activity (PEA) cardiac
arrest is poor and has not changed during the last 10 years. Effective chest
compressions may improve survival after PEA. Researchers investigated whether a
mechanical device (LUCAS-CPR) can ensure chest compressions during cardiac
arrest according to guidelines and without interruption during transport, diagnostic
procedures and in the catheter laboratory.
Method: We studied mechanical chest compression in 28 patients with PEA
(pulmonary embolism (PE) n=14; cardiogenic shock/acute myocardial infarction; n=9;
severe hyperkalemia; n=2; sustained ventricular arrhythmias/electrical storm; n=3) in a
university hospital setting.
Result: During or immediately after CPR, 21 patients underwent coronary
angiography and or pulmonary angiography. Successful return of a spontaneous
circulation (ROSC) was achieved in 27 out of the 28 patients. Ten patients died within
the first hour and three patients died within 24h after CPR. A total of 14 patients
survived and were discharged from hospital (13 without significant neurological deficit).
Interestingly, six patients with PE did not have thrombolytic therapy due to
contraindications. CT-angiography findings in these patients showed fragmentation of
the thrombus suggesting thrombus breakdown as an additional effect of mechanical

chest compressions. No patients exhibited any life-threatening device-related


complications.
Conclusion: Continuous chest compression with an automatic mechanical
device is feasible, safe, and might improve outcomes after in-hospital-resuscitation of
PEA. Patients with PE may benefit from effective continuous chest compression,
probably due to thrombus fragmentation and increased pulmonary artery blood flow.
Based on the study, the researchers discussed that in six patients that had
pulmonary emboli but contraindications to thrombolysis, it was possible that the LUCAS
compressions alone were responsible for the thrombus fragmentation. The authors
noted that the device bought time and allowed for interventional procedures and
treatments. They concluded the device was feasible, safe and might improve outcomes.

2. A pilot study of mechanical chest compressions with the LUCAS device in


cardiopulmonary resuscitation (Smekal, 2011)
Introduction: The LUCAS device has been shown to improve organ perfusion
during cardiac arrest in experimental studies. In this pilot study the aim was to compare
short-term survival between cardiopulmonary resuscitation (CPR) performed with
mechanical chest compressions using the LUCAS device and CPR performed with
manual chest compressions. The intention was to use the results for power calculation
in a larger randomized multicenter trial.

Method: In a prospective pilot study, from February 1, 2005, to April 1, 2007, 149
patients with out of hospital cardiac arrest in two Swedish cities were randomized to
mechanical chest compressions or standard CPR with manual chest compressions.
Result: After exclusion, the LUCAS and the manual groups contained 75 and 73
patients, respectively. In the LUCAS and manual groups, spontaneous circulation with a
palpable pulse returned in 30 and 23 patients (p=0.30), spontaneous circulation with
blood pressure above 80/50mmHg remained for at least 5 min in 23 and 19 patients ( p
=0.59), the number of patients hospitalized alive >4 h were 18 and 15 ( p=0.69), and
the number discharged, alive 6 and 7 (p=0.78), respectively.
Conclusion: In this pilot study of out-of-hospital cardiac arrest patients we found
no difference in early survival between CPR performed with mechanical chest
compression with the LUCAS device and CPR with manual chest compressions. Data
have been used for power calculation in a forthcoming multicenter trial.
Based on the study, the Automated Chest Compression Device has been shown
to improve organ perfusion during cardiac arrest. Though not significant, study shows
that spontaneous circulation with palpable pulse, spontaneous circulation with blood
pressure above 80/50 and the number of alive patient is greater in Cardiac Arrest
patients who used Automated Chest Compression Device than the Manual Cardio
Pulmonary Resuscitation.

3. An automated CPR device compared with standard chest compressions for


out-of-hospital resuscitation (Jennings, 2012)
Introduction: Effective cardiopulmonary resuscitation and increased coronary
perfusion pressures have been linked to improved survival from cardiac arrest. This
study aimed to compare the rates of survival between conventional cardiopulmonary
resuscitation (C-CPR) and automated CPR (A-CPR) using AutoPulse in adults
following out-of-hospital cardiac arrest (OHCA).
Method: This was a retrospective study using a matched casecontrol design
across three regional study sites in Victoria, Australia. Each case was matched to at
least two (maximum four) controls using age, gender, response time, presenting cardiac
rhythm and bystander CPR, and analyzed using conditional fixed-effects logistic
regression.
Result: During the period 1 October 2006 to 30 April 2010 there were 66 OHCA
cases using A-CPR. These were matched to 220 cases of OHCA involving the
administration of C-CPR only (controls). Survival to hospital was achieved in 26%
(17/66) of cases receiving A-CPR compared with 20% (43/220) of controls receiving CCPR and the propensity score adjusted odds ratio [AOR (95% CI)] was 1.69 (0.79,
3.63). Results were similar using only bystander witnessed OHCA cases with presumed
cardiac etiology. Survival to hospital was achieved for 29% (14/48) of cases receiving ACPR compared with 18% (21/116) of those receiving C-CPR [AOR = 1.80 (0.78, 4.11)].
Conclusion: The use of A-CPR resulted in a higher rate of survival to hospital
compared with C-CPR, yet a tendency for a lower rate of survival to hospital discharge,

however these associations did not reach statistical significance. Further research is
warranted which is prospective in nature, involves randomization and larger number of
cases to investigate potential sub-group benefits of A-CPR including survival to hospital
discharge.
Based on this study, using Automated Chest Compression Device results in
higher chances and rate of survival than the manual Cardio Pulmonary Resuscitation.
Study shows that higher rate of survival on hospital was achieved with patients
receiving Automated Chest Compression Device.

4. Does the LUCAS device result in increased injury during CPR? (Menzies, 2011)
Introduction: ILCOR guidelines emphasize high quality chest compressions at a
rate of 100/min. It is likely that this will be emphasized further in 2010. Accuracy and
depth of manual chest compressions decline rapidly. In an effort to combat this,
attention has focused on the development of mechanical chest compression devices.
The LUCAS is a mechanical piston driven by compressed air, oxygen or battery. It has
the potential to produce dramatic perfusion rates in animal models but has also been
associated with significant intra-thoracic and intra-abdominal trauma.
Method: 80 Cases of CPR at two different Emergency Departments were
compared. The LUCAS is routinely employed in all cardiac arrests where CPR is
attempted in one ED. Manual CPR only is currently employed in the second ED. All
patients would also have received manual CPR pre hospital and standard resuscitation
protocols were followed in both EDs. Computerized and paper records were searched

to identify all patients who received CPR. Post mortem findings were analyzed
retrospectively for CPR-related trauma.
Result: Researchers retrieved records on 40 patients in the LUCAS CPR group
and 39 in the manual CPR group. Rib fractures were present in 13/40 in the LUCAS
CPR group and 19/39 in the manual CPR group. Pearson's Chi-Square Test, P=0.142.
Sternal fractures were present in 9/40 in the LUCAS CPR group and 16/39 in the
manual CPR group. Pearson's Chi-Square Test, P=0.144. Mean number of rib
fractures in the LUCAS CPR group was 1.84 and in the manual CPR group was 3.21.
This difference was not significant on the MannWhitney U-test (P=0.096).
Conclusion: We did not identify a significant variation in trauma with the use of
the LUCAS compared to manual CPR. We do not believe that use of this device should
be withheld on the basis of trauma related to CPR.
Based on the study, the researchers concluded that they could not identify a
significant variation in trauma with the use of the LUCAS compared to manual CPR.
Although not significant, results show that Rib Fractures were reported to be higher in
Manual Cardio Pulmonary Resuscitation than in Automated Chest Compression.

5. Effect of the AutoPulse automated band chest compression device on


hemodynamics in out-of-hospital cardiac arrest resuscitation. (Duchateau, 2011)
Introduction: Guidelines for advanced life support of cardiac arrest (CA)
emphasize continuous and effective chest compressions as one of the main factors of
cardiopulmonary resuscitation (CPR) success. The use of an automated load

distributing chest compression device for CPR is promising but initial studies on
survival show contradictory results. The aim of this study was to evaluate the effects of
AutoPulse on blood pressure (BP) in out-of-hospital CA patients.
Method: This prospective study included adult patients presenting with in
refractory out-of-hospital CA. Invasive arterial BP produced by AutoPulse was
compared to BP generated by manual CPR (Active Compression Decompression).
Systolic, diastolic and mean BP and end-tidal carbon dioxide were recorded before and
after initiating the automated band device for each patient. The comparison of diastolic
BP produced by manual CPR versus automated chest compressions was the primary
end point.
Result: Hemodynamics in 29 patients are reported and analyzed. Median
diastolic BP increased after starting AutoPulse from 17[11-25] mmHg to 23[18-28]
mmHg (P < 0.001). Median systolic BP increased from 72[55-105] mmHg to 106[78135] mmHg (P = 0.02). Mean BP increased from 29[25-38] mmHg to 36[30-15] mmHg
(P = 0.002). On the other hand, End-Tidal CO(2) did not increase significantly with
AutoPulse (21[13-36] vs. 22[12-35] mmHg, P = 0.80).
Conclusion: In patients with out-of-hospital CA, the use of AutoPulse is
associated with an increased diastolic BP compared to manual chest compressions.
While its benefit to survival has yet to be demonstrated, the increase in diastolic and
mean BP is a promising outcome for AutoPulse use.
Based on this study, the systolic and diastolic pressures of the patients increased
after using the Automated Chest Compression Device compared to Manual Chest

Compressions. This only suggests that utilization of ACCD increases the higher rate of
survival chances among cardiac arrest patients.

IV. Synthesis
Strengths
Automated Chest Compression Device delivers effective and consistent chest
compressions with minimum interruptions. Compared to manual chest compressions,
ACCD accurately gives at least 100 compressions per minute and 2 inches depth of
compression. The device also helps sustain blood circulation into the brain, the heart
and other vital organs. Studies has shown to improve blood flow to the brain compared
to manual CPR. It also allows other lifesaving interventions. With the help of the ACCD,
the nurses and other health care provider could function other lifesaving interventions
and treatment necessary for the patient. It also saves the energy and decreases the
chances of fatigability of the nurse or anyone performing the CPR. And lastly, it provides
safe chest compressions for patients. Research shows that compressions are safe with
the ACCD as the manual chest compression.

Weaknesses
Being in a third world country, the price and amount of ACCD is expensive
reaching for up to $14,000 per set of the said device. It will be hard for hospitals to

provide and invest in such devices. The device is also contraindicated for very obese
and very small patients. Also, patients with very heavy chest hair is contraindicated for
this device. With the advancement of the technology, there will also be a need in
providing knowledge and training programs in using these devices. Machine or
Technical errors might also happen during emergency cases where the device might not
be able to function properly, with this situation, the time and the intervention the client
needed by the client will be delayed increasing the risk for death.

Answer to the Statement of the Problem


1. Is Automated Chest Compression Device effective in responding to Cardiac Arrest
patients as compared to Manual Chest Compression?
Yes, the important observation here is that among any other aspects of using
Automated Chest Compression Device in responding to Cardiac Arrest Patients, it is
prevalent that the results are better than the Manual Cardio Pulmonary Resuscitation.
Study results shows higher chances of survival in utilizing the use of ACCD compare to
manual chest compressions.
2. What are the advantages of using Automated Chest Compression Device on nurses
and other health care providers?
One of advantages of using Automated Chest Compression Device on Nurses
and other Health Care Providers is that they have the time to perform other
interventions and treatment that might help and cure the cause of the patients cardiac
arrest. It is fundamental to determine the management of cardiac arrest rhythms in

order to provide treatment for the patient. With the use of ACCD, the availability of the
nurse and physician in performing interventions will be utilized.

3. Is Automated Chest Compression Device safe and reliable?


The safety and reliability of the device in the potential for injury to the patients is
the same with manual compressions as shown by the recent studies. Though not
significant, results show that using ACCD among patient has a lower rate of rib fractures
than those who are manually chest compressed patients.

V. Conclusion
In conclusion, Automated Chest Compression Device is a safe and efficient tool
that standardizes chest compressions in accordance with the latest scientific guidelines.
It provides the same quality for all patients and over time, independent of transport
conditions, rescuer fatigue, or variability in the experience level of the caregiver. By
doing this, it frees up rescuers to focus on other life-saving tasks and creates new
rescue opportunities.

VI. Recommendation
The researchers highly suggest the use of the Automated Chest Compression
Device in the near future. Also, we suggest to provide awareness among students on

the medical field, nurses, and other health care providers about the existence, functions,
and the great benefits of this device.

VII. Appendices
References
Bonnemeier, H. Continuous mechanical chest compression during in-hospital
cardiopulmonary resuscitation of patients with pulseless electrical activity.
http://www.ncbi.nlm.nih.gov/pubmed/21126816, February 2011.
Duchateau, F. Effect of the AutoPulse automated band chest compression device on
emodynamics in out-of-hospital cardiac arrest resuscitation.
http://www.ncbi.nlm.nih.gov/pubmed/20213073, July 2011.
Jennings, Paul An automated CPR device compared with standard chest
compressions for out-of-hospital resuscitation.
http://bmcemergmed.biomedcentral.com/articles/10.1186/1471-227X-12-8, 2012.
Menzies, D. Does the LUCAS device result in increased injury during CPR?
http://www.ncbi.nlm.nih.gov/pubmed/20213073, December 2011
Smekal, David A pilot study of mechanical chest compressions with the LUCAS
device in cardiopulmonary resuscitation.
ttp://www.lucas
pr.com/doc_en/LUCAS%20Sel%20Bib%20Summaries%20A4%203302304_B.pdf
June 2011