Cardiopulmonary resuscitation

Title: Cardiopulmonary resuscitation
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Abstract
The quality of Cardiopulmonary resuscitation (CPR) is essential in predicting the outcome of a cardiac arrest. The manual CPR is an alternative to mechanical chest-compression. Animal and physiological statistics indicate that the mechanical chest-compression devices are effective than the manual CPR. For that reason, there have been many attempts and much interest in developing the new techniques and equipment to improve the efficiency of CPR. This write up will consider comparison between manual and mechanical CPR, compare their effectiveness, cost, and the survival rate. Besides, studies with specific on perfusion pressure data and physiology comparing original types of mechanical devices and current devices and finally discussion of its use in various age groups and the efficacy of interposed ventilations with the devices (Steen 2002).
Introduction
In Cardiac resuscitation, the rhythmic application of some force to the body of an invalid is essential in generating blood flow. However, there is no concurrence on this technique of applying force. There is still a need for better external chest compression styles, because statics has it that only 5-15% of those treated with the standard CPR survive cardiac arrest, a) and that it is widely approved that increasing the blood flow that is generated by chest compression improves survival. b) Many chest compressions are done incorrectly. c) These incorrect chest compressions may pose a threat to survival. d) Thus, one way of bettering the quality of chest compression is the application of automatic mechanical devices, which apply compression with more consistency than by use of manual means. The automated mechanical devices provide high quality compressions in a moving ambulance that is almost impossible to accomplish using a manual CPR, and thus allow the reduction in the number of the personnel for emergency medical systems that are needed to do the resuscitation (McDonald 1982).
In rare but dramatic cases of cardiac arrest which are therapy resistant, for instance during PCI (primary percutaneous intervention in acute myocardial infarction, use of defibrillation only is usually unable to sufficient and spontaneous circulation. Such cases call for effective chest compressions so as to ensure proper cardiac and cerebral perfusion. Regular and proper, minimally interrupted CPR is compulsory in improving the result in cardiac arrest treatment.
However, applying manual CPR to patients is exceedingly difficult this is because: i) patience accessibility is made difficult by the cardiac angiography system and even by the operating cardiologists. ii) The catheterization lab table is very flexible hence not offering a strong basis. iii) The prolonging of the CPR during therapy in the catheterization laboratory leads to immature resuscitators’ exhaustion. iv) the risk that is posed by the radiation exposure (Steen 2002).
Mechanical CPR has as such been seen as the solution to these problems. There exists a growing number of the data on efficacy and safety of these devices. In Switzerland, the LUCAS and the Auto pulse exists as the two chest compression devices. Where the LUCAS is sterna compression device powered by gas or electricity while the Auto pulse is automated. The LUCAS has seen technological modification since the it was manufactured. As such in this review I will use the LUCAS 1 and LUCAS 2 to indicate the initial and the modified LUCAS device.
Device characteristics
The LUCAS piece of equipment is a pneumatic system that requires a gas port for the supply with compressed air. It has performed two sequences with no technical problems. It has a problem with over heating after the second sequence.
Manual chest compression
6 sequences were done manually and a sample of 6323 compression analyzed. These were done by two different teams each composed of three resuscitators carried out 3 situations of incessant chest compressions over 10mins, changing every 60seconds: thus amounting to changes in the resuscitator after 100comprressions.
Resuscitator characteristics
Manual CPR performance
These are as shown in the table 2 below. The mean manual rate of compression over 10mins of incessant chest compression was 105 per minute. Nevertheless, there existed a considerable range in the various sequences (88/min-121/min) Of the 6 sequences; an average of 70% of the overall compressions was classified as accurate, with a range of 54-91% in different sequences. 8 percent of all the sequences were classified as very deep and 21 percent as too shallow.
Mechanical chest compression
3 sequences of 10 minutes of incessant chest compressions were done using the LUCAS powered by electricity. 2 sequences were done using the LUCAS system that is driven by gas. In total 4957 mechanical compressions were done.
Mechanical CPR performance
The results are shown in the table below:
The mean manual compression rate over 10 mins of incessant chest compressions was 101 per minute. A narrow range in the various sequences (99-102 per minute). Over and above the four sequences, an average of 98% of all compressions were accurate with a range of two (from 97 -99%) in the different sequence. Zero compressions were termed as too deep while 1% too shallow. An average time of 10 seconds was noted for disturbance of chest compression over 10 minutes due to the installation of the equipment (Tunstall 1992).
Table 1 Resuscitator characteristics
GenderAge(Yrs)Weight in KgHeight in MBMI(Kg/m2)QualificationProfessional experienceTeam 1C.Rm26821.8224.8Dipl. Rs8.0M.Gm33841.9222.8Dipl. Rs14.0I.Mf32641.7221.6Dipl. Rs8.0mean30.376.71.8223.110.0Team 2S.Jm36731.8222.0Dipl. Rs10.0A.Hm32931.8128.4Dipl. Rs11.0C.Wm34681.7821.5Dr. med., ACLS Instructor10.0
Table 2 CPR performance Manual CPR Mechanical CPR
team 1team 2team 1team 2team 1team 2LUCAS 2LUCAS 2Device failure LUCAS 1LUCAS 1Sequence1234567891011Hands-off1288888111045910Compressions120612171131963888918990100591210231027Correct compressions%5476915477679997849998Too deep%440200100000Too shallow%0225452131021501Compression rate Per min12012111296889199100100102102
Comparison: mechanical versus manual chest compression
Performance with no dev ice failure
A comparison of 4 sequences of proper mechanical CPR (4957 compressions) with 6 sequences of the manual CPR (6323compressions). There existed no statistically significant variations concerning compression rate during the mechanical versus the manual CPR (101/min vs. 105/min: p=0.6192). The ratio of accurate compression depth was better in mechanical CPR i.e. 98% as compared to 70% of the manual CPR; p=0.0049) . The manual CPR resulted to too deep compression during the 8% of the total compressions unlike the mechanical CPR which showed no deep compressions (p=0.4120). The manual CPR as compared to the mechanical showed too shallow compressions.
Device failure
In a hospital setting, when a mechanical CPR fails, it calls for the use of a manual CPR. An analysis of the influence of a failure of a device on the entire mechanical performance discretely by involving sequence 9 in the comparison was done. A comparison of five sequences (where one has device failure) of mechanical CPR and with 6 sequences of manual CPR was also carried our. This found statistically no significant difference in relation to the compression rate during the mechanical VERSUS manual CPR (101/min vs. 105/min; p=0.5590). During the mechanical CPR the proportion of accurate compression rate was significantly better as compared to the manual: 95% vs 70%. The shallow compressions occurred less often during the mechanical CPR as compared to manual CPR: 4% compared to 21%.
Cost effectiveness of mechanical CPR
The mechanical CPR has various advantages over the manual CRP for its use of EMS vehicles. Cost effectiveness is increased by the use of mechanical CPR, through the reduction of the risk of injury to the ambulance crews. Statistical evidence has it that the ambulance staff that carry out CPR in moving ambulance do so without being controlled by seat belts or other protection devices. These ambulance s...