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ACAD-AE-MED  February 2003

ACAD-AE-MED February 2003

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Subject:

Re: Active compression/decompression devices for CPR.

From:

"Black, John" <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Thu, 27 Feb 2003 09:36:21 -0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (174 lines)

Hi Duncan!

In the ED what is essential is a step (or 2!) so that the resuscitator is in
a mechanically efficient position. I note that the latest models have a more
user friendly grip.

The daily technical challenge of performing chest compressions and effective
BVM for a single rescuer in a moving vehicle (ambulance) is enormous.

For some time I have wondered whether an alternative approach that may
result in more effective CPR in the unintubated in such circumstances might
be:

1. Nasal (x2 if possible) + oral airway

2. High flow O2 delivered via well fitting Hudson mask

3. Continuous chest compressions administered with ACD device

Getting ethical approval to develop the evidence base for such an approach
would be a challenge but such an approach might be of benefit for such
patients.

Does anyone feel this approach merits further evaluation?

John Black
Oxford






-----Original Message-----
From: Duncan Peacock [mailto:[log in to unmask]]
Sent: 21 February 2003 20:28
To: [log in to unmask]
Subject: Re: Active compression/decompression devices for CPR.

John (et al)

Hope you are well.

How do you find using the ACD in the department, i.e. with the patient on
the
trolley. I found and saw the benefits were more marked when in the
pre-hospital arena, the patient was on the floor and you could stand astride
them and really give it welly!, nearly lifting them up on the upstroke
definitely decreased their intrathoracic pressure, and increased your own -
the flushing and dilated scalp veins gave it away. It did seem to restart
the heart, but I don't think it got them back into the community,Im sure its
more effective than plain old Cardiac compressions especially if commenced
early.

Cheers

Duncan


----- Original Message -----
From: "Black, John" <[log in to unmask]>
To: <[log in to unmask]>
Sent: 21 February 2003 17:46
Subject: Re: Active compression/decompression devices for CPR.

forming
> My reasons for having been encouraged with the use of this device in the
> context of cardiac arrest both in and out of hospital (~20 patients):
>
> 1. Increased CO2 production when replacing hand delivered chest
compressions
> with this device as determined by EasyCap colour change.
>
> 2. Once in situ no concerns re position of rescuers hand position whose
> experience may be variable.
>
> 3. Good chest wall protection by spreading the load over a wider area of
the
> chest during chest compressions, especially in the elderly and frail.
>
> 4. The potential for effective passive ventilation (bellows effect) during
> CPR in the non-intubated patient on high flow oxygen and the potential
> relevance for a single individual performing CPR during transportation to
> hospital.
>
> I have not been able to attribute survival in any individual patient to
the
> use of this device alone (hardly surprisingly) but any device that
> potentially improves oxygenation and coronary blood merits further
> evaluation. I have elected to carry one as part of my prehospital care kit
> and we are currently evaluating it in our ED resuscitation room.
>
> I understand that the device largely fell out of use because of concerns
re
> back injuries when the device was used in the late 1980s.........
>
> John Black
> Oxford
>
> -----Original Message-----
> From: Plunkett, Patrick (Emergency Medicine) [mailto:[log in to unmask]]
> Sent: 21 February 2003 08:46
> To: [log in to unmask]
> Subject: Re: Active compression/decompression devices for CPR.
>
> Couldnt agree more
>
> -----Original Message-----
> From: Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR
> [mailto:[log in to unmask]]
> Sent: 21 February 2003 08:42
> To: [log in to unmask]
> Subject: Re: Active compression/decompression devices for CPR.
>
>
> >
> > John, I still have an AMBU ACD device in my training room but
> > it has been
> > unused for over 6 years.
> >
> > It seemed to to drop out of fashion as it was hard work &
> > studies showed
> > little advantage (?Canadian sources). Except in Paris where the SAMU &
> > pompiers adopted it enthusiastically. Their studies supported it with
> > increased ROSC.
> >
>
> This is the problem with the great majority of studies on treatments for
> cardiac arrest: ROSC or survival to hospital admission is taken as an end
> point. I appreciate that the numbers required to look at neurologically
> acceptable discharge from hospital need to be considerably larger, but
ROSC
> can just mean a prolonged, expensive and unpleasant death and as such is
an
> adverse event in some patients rather than a sensible proxy. Patients with
a
> good survival are a subset of those with ROSC. Unless ROSC is confined to
> one arm of the study it cannot be said that it predicts which arm will
have
> more acceptable outcomes. It surprises me that these days RECs still
> consider it ethical to conduct a study  and journals still print it with
> ROSC (instead of survival to discharge with reasonable neurological
outcome)
> as an endpoint.
> Can I plead to anyone conducting reviews (or indeed primary research) to
> look specifically at sensible endpoints instead of ROSC or survival to
> hospital arrival.
>
> Matt Dunn
> Warwick
>
>
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to
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> The opinions expressed in this email represent the views of the sender,
not
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