Assessment of CPR interruptions from transthoracic impedance during use of the LUCAS™ mechanical chest compression system.
BACKGROUND
Quality of cardiopulmonary resuscitation (CPR) is a key determinant of outcome following out-of-hospital cardiac arrest (OHCA). Recent evidence shows manual chest compressions are typically too shallow, interruptions are frequent and prolonged, and incomplete release between compressions is common. Mechanical chest compression systems have been developed as adjuncts for CPR but interruption of CPR during their use is not well documented.


OBJECTIVE
Analyze interruptions of CPR during application and use of the LUCAS™ chest compression system.


METHODS
54 LUCAS 1 devices operated on compressed air, deployed in 3 major US emergency medical services systems, were used to treat patients with OHCA. Electrocardiogram and transthoracic impedance data from defibrillator/monitors were analyzed to evaluate timing of CPR. Separately, providers estimated their CPR interruption time during application of LUCAS, for comparison to measured application time.


RESULTS
In the 32 cases analyzed, compressions were paused a median of 32.5s (IQR 25-61) to apply LUCAS. Providers' estimates correlated poorly with measured pause length; pauses were often more than twice as long as estimated. The average device compression rate was 104/min (SD 4) and the average compression fraction (percent of time compressions were occurring) during mechanical CPR was 0.88 (SD 0.09).


CONCLUSIONS
Interruptions in chest compressions to apply LUCAS can be <20s but are often much longer, and users do not perceive pause time accurately. Therefore, we recommend better training on application technique, and implementation of systems using impedance data to give users objective feedback on their mechanical chest compression device use.
Resurgent Biomedical Consulting LLC, 16913 17th DR SE Mill Creek, WA 98012, United States. dyost@resurgentbiomedical.com
Dana
D
Yost
Reid H
RH
Phillips
Louis
L
Gonzales
Charles J
CJ
Lick
Paul
P
Satterlee
Michael
M
Levy
Joseph
J
Barger
Pamela
P
Dodson
Stephen
S
Poggi
Karen
K
Wojcik
Robert A
RA
Niskanen
Fred W
FW
Chapman
D002307:Cardiography, Impedance; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011795:Surveys and Questionnaires