Embed Size (px)
DESCRIPTION
Mechanical devices for cardiac massage: must-have or luxury? . Giuseppe Biondi-Zoccai , MD Sapienza University of Rome , Italy [email protected]. Learning goals. Why do we need mechanical devices for cardiac massage Which devices are available What are their pros - PowerPoint PPT Presentation
Citation preview
Mechanical devices for cardiac massage:
must-have or luxury? Giuseppe Biondi-Zoccai, MD
Sapienza University of Rome, [email protected]
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
AutoPulse
LUCAS
LUCAS
CardioPump ACD-CPR
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
Case studyAge: 40 yearsGender: maleComorbidities: type 1 diabetes mellitusDiagnosis: acute myocardial infarction Prehospital events/management: VF treated with DC shock, followed by PEA; manual chest compression, repeat IV adrenaline boluses, tracheal intubation, mechanical ventilationHospital 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.
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:
