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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:

Fri, 28 Feb 2003 12:07:20 -0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (243 lines)

Alan,

We do have a thumper in our ED which we have used for prolonged
resuscitation attempts (hypothermia when access to cardiopulmonary has been
an issue).

Although automated it does not actively decompress the chest and therefore
would not be in my view be as effective as the AED in providing bellows type
ventilation, which would be potentially important for oxygenation in the
context of continuous chest compressions.

The thumper as you know is heavy, bulky and cumbersome, and thus less
attractive for use in prehospital care.

In terms of alternative ventilation strategy in the context below would be
an LMA and continuous chest compressions via AED, but there resource
implications as well as training issues for technician crews.

John

-----Original Message-----
From: Alan Montague [mailto:[log in to unmask]]
Sent: 28 February 2003 10:49
To: [log in to unmask]
Subject: Re: Active compression/decompression devices for CPR.

Would "The Thumper" not have a role in these
circumstances (single rescuer with two tasks)?

Alan


 --- "Black, John" <[log in to unmask]> wrote: > 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)
>
=== message truncated ===

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