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      Rescue under ongoing CPR from an upper floor: evaluation of three different evacuation routes and mechanical and manual chest compressions: a manikin trial

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          Abstract

          Background

          If transport under ongoing cardiopulmonary resuscitation (CPR) from an upper floor is indicated, the ideal CPR-method and evacuation route is unknown hitherto. We aimed to elaborate a strategy for evacuation of patients under ongoing CPR from an upper floor, comparing three different evacuation routes and manual and mechanical chest compressions.

          Methods

          A CPR-training manikin recording CPR-quality was placed on the fifth floor and was evacuated to an ambulance via lift, turntable ladder, or staircase. Chest compressions were performed manually or with a mechanical CPR-device. Efficiency endpoints were compression depth and frequency, sufficiency of chest release, compared with European Resuscitation Council (ERC) Guidelines, and duration of the evacuation. Adverse outcomes were disconnection/dislocation of devices and hazards/accidents to the personnel.

          Results

          For all evacuation routes, compression depth and frequency were significantly more compliant with ERC-guidelines under mechanical CPR. Manual CPR was associated with considerable deviations from correct compression depth and frequency. Chest release only slightly differed between groups. Evacuation via lift under mechanical CPR was fastest and evacuation via turntable ladder under manual CPR was slowest. No device disconnections or accidents occurred, but hazard to personnel was perceived during evacuation via ladder under manual CPR.

          Conclusions

          In this study, a mechanical CPR-device proved to deliver better CPR-quality during evacuation from an upper floor. If a lift accessible with a stretcher is available, this route should be preferred, regardless of manual or mechanical CPR. Turntable ladders can only be meaningfully used with mechanical CPR, otherwise CPR-quality is poor and hazard to the personnel is increased. Not all evacuation routes may be useable in a specific real-life scenario.

          Trial registration

          German Clinical Trials Registry, www.drks.de, registration number DRKS00012885, registration date 17.08.2017.

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          Most cited references19

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          European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support.

          Jasmeet Soar, Jerry P Nolan, Bernd W Böttiger … (2015)
          Article 0 comments Cited 348 times – based on 0 reviews     Review now
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            Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial.

            Gavin D Perkins, Ranjit Lall, Tom Quinn … (2015)
            Mechanical chest compression devices have the potential to help maintain high-quality cardiopulmonary resuscitation (CPR), but despite their increasing use, little evidence exists for their effectiveness. We aimed to study whether the introduction of LUCAS-2 mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest.
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              Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial.

              Sten Rubertsson, Erik Lindgren, David Smekal … (2014)
              A strategy using mechanical chest compressions might improve the poor outcome in out-of-hospital cardiac arrest, but such a strategy has not been tested in large clinical trials. To determine whether administering mechanical chest compressions with defibrillation during ongoing compressions (mechanical CPR), compared with manual cardiopulmonary resuscitation (manual CPR), according to guidelines, would improve 4-hour survival. Multicenter randomized clinical trial of 2589 patients with out-of-hospital cardiac arrest conducted between January 2008 and February 2013 in 4 Swedish, 1 British, and 1 Dutch ambulance services and their referring hospitals. Duration of follow-up was 6 months. Patients were randomized to receive either mechanical chest compressions (LUCAS Chest Compression System, Physio-Control/Jolife AB) combined with defibrillation during ongoing compressions (n = 1300) or to manual CPR according to guidelines (n = 1289). Four-hour survival, with secondary end points of survival up to 6 months with good neurological outcome using the Cerebral Performance Category (CPC) score. A CPC score of 1 or 2 was classified as a good outcome. Four-hour survival was achieved in 307 patients (23.6%) with mechanical CPR and 305 (23.7%) with manual CPR (risk difference, -0.05%; 95% CI, -3.3% to 3.2%; P > .99). Survival with a CPC score of 1 or 2 occurred in 98 (7.5%) vs 82 (6.4%) (risk difference, 1.18%; 95% CI, -0.78% to 3.1%) at intensive care unit discharge, in 108 (8.3%) vs 100 (7.8%) (risk difference, 0.55%; 95% CI, -1.5% to 2.6%) at hospital discharge, in 105 (8.1%) vs 94 (7.3%) (risk difference, 0.78%; 95% CI, -1.3% to 2.8%) at 1 month, and in 110 (8.5%) vs 98 (7.6%) (risk difference, 0.86%; 95% CI, -1.2% to 3.0%) at 6 months with mechanical CPR and manual CPR, respectively. Among patients surviving at 6 months, 99% in the mechanical CPR group and 94% in the manual CPR group had CPC scores of 1 or 2. Among adults with out-of-hospital cardiac arrest, there was no significant difference in 4-hour survival between patients treated with the mechanical CPR algorithm or those treated with guideline-adherent manual CPR. The vast majority of survivors in both groups had good neurological outcomes by 6 months. In clinical practice, mechanical CPR using the presented algorithm did not result in improved effectiveness compared with manual CPR. clinicaltrials.gov Identifier: NCT00609778.
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                Author and article information

                Contributors
                Hendrik Drinhaus:
                ORCID: http://orcid.org/0000-0001-8435-2246
                hendrik.drinhaus@uk-koeln.de
                Journal
                Journal ID (nlm-ta): Scand J Trauma Resusc Emerg Med
                Journal ID (iso-abbrev): Scand J Trauma Resusc Emerg Med
                Title: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1757-7241
                Publication date (Electronic): 4 March 2020
                Publication date PMC-release: 4 March 2020
                Publication date Collection: 2020
                Volume: 28
                Electronic Location Identifier: 16
                Affiliations
                [1 ]ISNI 0000 0000 8580 3777, GRID grid.6190.e, Department of Anaesthesiology and Intensive Care Medicine, , University of Cologne, Faculty of Medicine and University Hospital of Cologne, ; Kerpener Str. 62, 50937 Cologne, Germany
                [2 ]Fire Brigade, Brühl, North Rhine-Westphalia Germany
                Author information
                http://orcid.org/0000-0001-8435-2246
                Article
                Publisher ID: 709
                DOI: 10.1186/s13049-020-0709-0
                PMC ID: 7055089
                PubMed ID: 32131894
                SO-VID: 6c2e4a49-3d24-4321-9694-301a71ac8751
                Copyright © © The Author(s). 2020
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 17 October 2019
                Date accepted : 5 February 2020
                Categories
                Subject: Original Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: out-of-hospital cardiac arrest,cardiopulmonary resuscitation,emergency medical services,transport under ongoing cardiopulmonary resuscitation,fire service,mechanical chest compressions
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: out-of-hospital cardiac arrest, cardiopulmonary resuscitation, emergency medical services, transport under ongoing cardiopulmonary resuscitation, fire service, mechanical chest compressions

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