Automatic and manual devices for cardiopulmonary resuscitation: A review

Rate of survival without any neurological consequence after cardiac arrest is driven not only by early recognition but also by high-quality cardiopulmonary resuscitation. Because the effectiveness of the manual cardiopulmonary resuscitation is usually impaired by rescuers’ fatigue, devices have been devised to improve it by appliances or ergonomic solutions. However, some devices are thought to replace the manual resuscitation altogether, either mimicking its action or generating hemodynamic effects with working principles which are entirely different. This article reviews such devices, both manual and automatic. They are mainly classified by actuation method, applied force, working space, and positioning time. Most of the trials and meta-analyses have not demonstrated that chest compressions given with automatic devices are more effective than those given manually. However, advances in clinical research and technology, with an improved understanding of the organizational implications of their use, are constantly improving the effectiveness of such devices.

[1]  V. Wenzel,et al.  Automatic mechanical device to standardize active compression-decompression CPR. , 1995, Annals of emergency medicine.

[2]  J. Townend,et al.  Automated cardiopulmonary resuscitation using a load-distributing band external cardiac support device for in-hospital cardiac arrest: a single centre experience of AutoPulse-CPR. , 2015, International journal of cardiology.

[3]  S. Thomas,et al.  Decay in quality of closed-chest compressions over time. , 1995, Annals of emergency medicine.

[4]  P. Agostoni,et al.  Successful percutaneous treatment of an intraprocedural left main stent thrombosis with the support of an automatic mechanical chest compression device. , 2008, International journal of cardiology.

[5]  H. Sandler,et al.  CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device: a multicentre study of victims after unsuccessful resuscitation. , 2014, Resuscitation.

[6]  F. Guyette,et al.  Cardiac Arrest Resuscitation. , 2015, Emergency medicine clinics of North America.

[7]  W. Dick,et al.  Comparison of Standard Cardiopulmonary Resuscitation Versus the Combination of Active Compression-Decompression Cardiopulmonary Resuscitation and an Inspiratory Impedance Threshold Device for Out-of-Hospital Cardiac Arrest , 2003, Circulation.

[8]  P. Steen,et al.  Effects of Interrupting Precordial Compressions on the Calculated Probability of Defibrillation Success During Out-of-Hospital Cardiac Arrest , 2002, Circulation.

[9]  L. Rasmussen,et al.  Improved survival after an out‐of‐hospital cardiac arrest using new guidelines , 2008, Acta anaesthesiologica Scandinavica.

[10]  S. Achenbach,et al.  Complete recovery after out-of-hospital cardiac arrest with prolonged (59 min) mechanical cardiopulmonary resuscitation, mild therapeutic hypothermia and complex percutaneous coronary intervention for ST-elevation myocardial infarction. , 2014, Heart & lung : the journal of critical care.

[11]  J. Ornato,et al.  Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation. , 2006, JAMA.

[12]  U. Eriksson,et al.  Mechanical versus manual chest compression CPR under ground ambulance transport conditions , 2013, Acute cardiac care.

[13]  J. Lubin,et al.  The Efficacy of LUCAS in Prehospital Cardiac Arrest Scenarios: A Crossover Mannequin Study , 2017, The western journal of emergency medicine.

[14]  Antonio Pedotti,et al.  The Abdominal Circulatory Pump , 2009, PloS one.

[15]  E. Omerovic,et al.  Successful percutaneous coronary intervention during cardiac arrest with use of an automated chest compression device: a case report , 2014, Therapeutics and clinical risk management.

[16]  H. Halperin,et al.  Cardiopulmonary resuscitation with a hydraulic-pneumatic band , 2000, Critical care medicine.

[17]  J. Love,et al.  Manual and Automated Cardiopulmonary Resuscitation (CPR): A Comparison of Associated Injury Patterns , , 2013, Journal of forensic sciences.

[18]  A. Hoeft,et al.  Out-of-hospital cardiopulmonary resuscitation with the AutoPulse system: a prospective observational study with a new load-distributing band chest compression device. , 2007, Resuscitation.

[19]  M. Ong,et al.  Improving the quality of cardiopulmonary resuscitation by training dedicated cardiac arrest teams incorporating a mechanical load-distributing device at the emergency department. , 2013, Resuscitation.

[20]  K. Cheng,et al.  Effectiveness of mechanical chest compression for out‐of‐hospital cardiac arrest patients in an emergency department , 2015, Journal of the Chinese Medical Association : JCMA.

[21]  P. Steen,et al.  Effects of Interrupting Precordial Compressions on the Calculated Probability of Defibrillation Success During Out-of-Hospital Cardiac Arrest , 2002 .

[22]  G. Perkins,et al.  The cost-effectiveness of a mechanical compression device in out-of-hospital cardiac arrest. , 2017, Resuscitation.

[23]  G. Perkins,et al.  Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation. , 2017, Health technology assessment.

[24]  Alice Y. M. Jones Can cardiopulmonary resuscitation injure the back? , 2004, Resuscitation.

[25]  G. Yedukondalu,et al.  Mechanical chest compression with a medical parallel manipulator for cardiopulmonary resuscitation , 2015, The international journal of medical robotics + computer assisted surgery : MRCAS.

[26]  S. Ohta,et al.  Application of an automated cardiopulmonary resuscitation device for kidney transplantation from uncontrolled donation after cardiac death donors in the emergency department , 2010, Clinical transplantation.

[27]  K. Kern,et al.  Current Approaches to Cardiopulmonary Resuscitation. , 2015, Current problems in cardiology.

[28]  J. Tsou,et al.  Mechanical loading of the low back during cardiopulmonary resuscitation. , 2009, Resuscitation.

[29]  C. Ellingsen,et al.  Cardiac arrest with continuous mechanical chest compression during percutaneous coronary intervention. A report on the use of the LUCAS device. , 2007, Resuscitation.

[30]  N. Frey,et al.  Continuous mechanical chest compression during in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activity. , 2011, Resuscitation.

[31]  Harald Herkner,et al.  Safety, feasibility, and hemodynamic and blood flow effects of active compression–decompression of thorax and abdomen in patients with cardiac arrest* , 2008, Critical care medicine.

[32]  J. Harnek,et al.  Mechanical chest compressions in the coronary catheterization laboratory to facilitate coronary intervention and survival in patients requiring prolonged resuscitation efforts , 2016, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

[33]  E. Lerner,et al.  Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. , 2014, Resuscitation.

[34]  K. Kern,et al.  Mechanical Cardiopulmonary Resuscitation In and On the Way to the Cardiac Catheterization Laboratory. , 2016, Circulation journal : official journal of the Japanese Circulation Society.

[35]  A randomized comparison of manual, mechanical and high-impulse chest compression in a porcine model of prolonged ventricular fibrillation. , 2005, Resuscitation.

[36]  B. Cander,et al.  Comparative effectiveness of standard CPR vs active compression-decompression CPR with CardioPump for treatment of cardiac arrest. , 2016, The American journal of emergency medicine.

[37]  Jamie L. Estock,et al.  Comparison of chest compression interruption times across 2 automated devices: a randomized, crossover simulation study. , 2016, The American journal of emergency medicine.

[38]  A. Keenan,et al.  Effect of rescuer fatigue on performance of continuous external chest compressions over 3 min. , 2002, Resuscitation.

[39]  Jonathan Hulme,et al.  Rescuer fatigue under the 2010 ERC guidelines, and its effect on cardiopulmonary resuscitation (CPR) performance , 2012, Emergency Medicine Journal.

[40]  S. Rubertsson,et al.  A pilot study of mechanical chest compressions with the LUCAS™ device in cardiopulmonary resuscitation. , 2011, Resuscitation.

[41]  G. Perkins,et al.  Mechanical chest compression for out of hospital cardiac arrest: Systematic review and meta-analysis. , 2015, Resuscitation.

[42]  R. Swor,et al.  Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2015, Circulation.

[43]  Vladimir A. Protopopescu,et al.  Optimal control applied to a thoraco-abdominal CPR model. , 2008, Mathematical medicine and biology : a journal of the IMA.

[44]  R. Berg,et al.  Microcirculatory and therapeutic effects of whole body periodic acceleration (pGz) applied after cardiac arrest in pigs. , 2011, Resuscitation.

[45]  M. Ong,et al.  Cardiopulmonary resuscitation interruptions with use of a load-distributing band device during emergency department cardiac arrest. , 2010, Annals of emergency medicine.

[46]  H. Halperin,et al.  Improved hemodynamic performance with a novel chest compression device during treatment of in-hospital cardiac arrest. , 2004, Resuscitation.

[47]  Farhan Bhanji,et al.  Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2015, Circulation.

[48]  Jose A. Adams,et al.  Post-resuscitation reperfusion injury: comparison of periodic Gz acceleration versus Thumper CPR. , 2006, Resuscitation.

[49]  M. Helm,et al.  Mechanical chest compression: an alternative in helicopter emergency medical services? , 2015, Internal and Emergency Medicine.

[50]  M. Körner,et al.  Computed tomography during cardiopulmonary resuscitation using automated chest compression devices—an initial study , 2009, European Radiology.

[51]  R. Swor,et al.  Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial , 2011, The Lancet.

[52]  B. Abella,et al.  Chest Compression Rates During Cardiopulmonary Resuscitation Are Suboptimal: A Prospective Study During In-Hospital Cardiac Arrest , 2005, Circulation.

[53]  P. Mangin,et al.  Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS™2): a forensic autopsy study , 2015, International Journal of Legal Medicine.

[54]  D. Stub,et al.  Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). , 2015, Resuscitation.

[55]  Makoto Ito,et al.  Successful kidney transplantation from donation after cardiac death using a load-distributing-band chest compression device during long warm ischemic time. , 2009, Resuscitation.

[56]  H. Halperin,et al.  A preliminary study of cardiopulmonary resuscitation by circumferential compression of the chest with use of a pneumatic vest. , 1993, The New England journal of medicine.

[57]  Benjamin S Abella,et al.  The challenge of CPR quality: improvement in the real world. , 2008, Resuscitation.

[58]  S. Rubertsson,et al.  No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS device--a pilot study. , 2009, Resuscitation.

[59]  David D. Salcido,et al.  Feasibility of Biosignal-guided Chest Compression During Cardiopulmonary Resuscitation: A Proof of Concept. , 2016, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[60]  A. Jonkisz,et al.  Cardiac arrest during percutaneous coronary intervention in a patient ‘resistant’ to clopidogrel – successful 50-minute mechanical chest compression , 2013, Postepy w kardiologii interwencyjnej = Advances in interventional cardiology.

[61]  Michael Casner,et al.  THE IMPACT OF A NEW CPR ASSIST DEVICE ON RATE OF RETURN OF SPONTANEOUS CIRCULATION IN OUT-OF-HOSPITAL CARDIAC ARREST , 2005, Prehospital Emergency Care.

[62]  Gavin D Perkins,et al.  Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial , 2015, The Lancet.

[63]  C F Babbs,et al.  CPR techniques that combine chest and abdominal compression and decompression: hemodynamic insights from a spreadsheet model. , 1999, Circulation.

[64]  Hua Yan,et al.  Continuous Mechanical Chest Compression-assisted Percutaneous Coronary Intervention in a Patient with Cardiac Arrest Complicating Acute Myocardial Infarction , 2015, Chinese medical journal.

[65]  Audrius Paskevicius,et al.  The critical importance of minimal delay between chest compressions and subsequent defibrillation: a haemodynamic explanation. , 2003, Resuscitation.

[66]  Monique L. Anderson,et al.  Part 6: Alternative Techniques and Ancillary Devices for Cardiopulmonary Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2015, Circulation.

[67]  Petter Andreas Steen,et al.  Manikins With Human-Like Chest Properties—A New Tool for Chest Compression Research , 2008, IEEE Transactions on Biomedical Engineering.

[68]  J. Smeets,et al.  Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies. , 2016, Annals of emergency medicine.

[69]  H. Friberg,et al.  Submersion, accidental hypothermia and cardiac arrest, mechanical chest compressions as a bridge to final treatment: a case report , 2009, Scandinavian journal of trauma, resuscitation and emergency medicine.

[70]  L. Svensson,et al.  Clinical consequences of the introduction of mechanical chest compression in the EMS system for treatment of out-of-hospital cardiac arrest-a pilot study. , 2006, Resuscitation.

[71]  A. Forti,et al.  Full recovery after prolonged cardiac arrest and resuscitation with mechanical chest compression device during helicopter transportation and percutaneous coronary intervention. , 2014, The Journal of emergency medicine.

[72]  P. Steen,et al.  Quality of cardiopulmonary resuscitation before and during transport in out-of-hospital cardiac arrest. , 2008, Resuscitation.

[73]  T. Rea,et al.  Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. , 2006, JAMA.

[74]  Roger D. White,et al.  Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2010, Circulation.

[75]  Jose A. Adams,et al.  Cardiopulmonary resuscitation (CPR) using periodic acceleration (pGz) in an older porcine model of ventricular fibrillation. , 2004, Resuscitation.

[76]  S. Krantz,et al.  Mechanical Versus Manual Chest Compressions in Out-of-Hospital Cardiac Arrest: A Meta-Analysis* , 2013, Critical care medicine.

[77]  F J Ochoa,et al.  The effect of rescuer fatigue on the quality of chest compressions. , 1998, Resuscitation.

[78]  Y. Inoue,et al.  The analysis of efficacy for AutoPulse™ system in flying helicopter. , 2013, Resuscitation.

[79]  J. Herlitz,et al.  Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial. , 2014, JAMA.

[80]  G. Lamas,et al.  Echocardiographic comparison of cardiopulmonary resuscitation (CPR) using periodic acceleration (pGz) versus chest compression. , 2005, Resuscitation.

[81]  Charles F Babbs,et al.  Biophysics of cardiopulmonary resuscitation with periodic z-axis acceleration or abdominal compression at aortic resonant frequencies. , 2006, Resuscitation.

[82]  S. Brooks,et al.  Mechanical versus manual chest compressions for cardiac arrest. , 2018, The Cochrane database of systematic reviews.

[83]  F. Pedross,et al.  LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue-a prospective, randomized, cross-over manikin study. , 2013, The American journal of emergency medicine.

[84]  Zhi Xiong Koh,et al.  Improved neurologically intact survival with the use of an automated, load-distributing band chest compression device for cardiac arrest presenting to the emergency department , 2012, Critical Care.

[85]  M. Helm,et al.  Cardio pump reloaded: in-hospital resuscitation during transport , 2013, Internal and Emergency Medicine.

[86]  G. Perkins,et al.  Mechanical chest compression devices at in-hospital cardiac arrest: A systematic review and meta-analysis. , 2016, Resuscitation.

[87]  C. Terkelsen,et al.  Cardiac arrest in the catheterisation laboratory: a 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. , 2010, Resuscitation.

[88]  Antonio Pedotti,et al.  Concomitant ventilatory and circulatory functions of the diaphragm and abdominal muscles. , 2010, Journal of applied physiology.

[89]  TingYu,et al.  Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation , 2002 .

[90]  H. Halperin,et al.  Mechanical CPR devices , 2010 .

[91]  Nathan Burkhart,et al.  Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device. , 2013, Resuscitation.

[92]  M. Manyalich,et al.  Liver Transplant Using Donors After Unexpected Cardiac Death: Novel Preservation Protocol and Acceptance Criteria , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.