Devices to enhance organ perfusion during cardiopulmonary resuscitation

ABSTRACT

Introduction

The recommended method of cardiopulmonary resuscitation (CPR) has been closed-chest cardiac compressions, but the development of CPR adjunctive devices has called into question the efficacy and role of these adjunctive devices. In this review, we provide a comprehensive evaluation and discussion on the commercially available noninvasive CPR adjuncts used during out-of-hospital cardiac arrest (OHCA).

Areas Covered

We review the three most common CPR adjunctive devices: the piston mechanism, the load distributing band, and the impedance threshold device. All three CPR adjunctive devices have preclinical data to support their use during cardiac arrest. In clinical trials, limited data show improvement in survival and neurologic recovery for these devices, and there is insufficient high-level evidence to support their use over manual chest compressions. However, there is a role for them when adequate manual chest compressions are not feasible.

Expert Opinion

The commercially available CPR adjuncts do not consistently show improved outcomes in the literature. There is still a need for research and development into innovative solutions to improve OHCA survival and neurologic recovery. Efforts focused on increasing the speed of CPR initiation and increasing perfusion to the cerebral and coronary vasculature have the potential to advance resuscitative practices.

KEYWORDS:

• Cardiopulmonary resuscitation
• CPR adjuncts
• return of spontaneous circulation
• CPR device
• chest compressions

Disclosures

In accordance with Taylor & Francis policy and my ethical obligation as a researcher, I am reporting that JBS, JK, and KMQ are co-founders of the company, Heartbeat Technologies, LLC, and JBS, JK, KMQ, and TKR have a provisional patent on External Vascular Compression Device for Use During Cardiac Arrest, provisional patent #63/144,599, both of which may be affected by the research reported in the enclosed paper. I have disclosed those interests fully to Taylor & Francis, and I have in place an approved plan for managing any potential conflicts arising from that involvement.

Article highlights

• The piston mechanism, impedance threshold, and load-distributing band mechanism demonstrated efficacy in preclinical studies.

• Current devices have failed to consistently improve survival compared to standard CPR in clinical trials.

• Current devices have failed to consistently improve neurologic recovery compared to standard CPR in clinical trials.

• Mechanical CPR is beneficial when manual compressions are not feasible.

• There is a clinically unmet need for improving CPR outcomes.

Declaration of interest

JB Siegel, J Kim, KM Quinn & TK Rajab are supported by the South Carolina Clinical & Translational Research Institute through CTSA NIH/NCATS grant number UL1 TR001450. JB Siegel, J Kim, KM Quinn, & TK Rajab are co-founders of the company, Heartbeat Technologies, LLC, and have a provisional patent on External Vascular Compression Device for Use During Cardiac Arrest, provisional patent #63/144,599. JH Kwon & B Gerry are supported by an NIH-NHLBI Institutional Postdoctoral Training Grant (T32 HL-007260). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the South Carolina Clinical & Translational Research Institute through CTSA NIH/NCATS grant number UL1 TR001450 to JB Siegel, J Kim, KM Quinn and TK Rajab. It was also supported through an NIH-NHLBI Institutional Postdoctoral Training Grant (T32 HL-007260) to J Kwon and B Gerry.