Mechanical adjuncts for cardiocerebral resuscitation

ABSTRACT

Introduction: Cardiac arrest remains a worldwide health problem with very poor outcome. In the absence of bystander resuscitation, survival rates decrease by 10% per minute of arrest and global ischemia. Even the best manual chest compressions, however, can only produce a fraction of normal cardiac output and blood flow to vital organs. Physiological principles and current evidence for the use of mechanical devices to increase survival and quality of life after cardiac arrest are highlighted in this review article.

Areas covered: Mechanical adjuncts such as the Active Compression Decompression device, automated chest compressors and the use of a negative pressure valve (Impedance Threshold Device) can synergistically aid in improving quality of CPR and increasing cardiac output and vital organ perfusion.

Expert opinion: The current conclusions that the use of mechanical adjunct devices in a preclinical setting is not recommended or neutral at best, need to be reevaluated, especially with regard to new advanced and promising treatments that require prolonged high-quality CPR during the transport to a hospital to improve the outcome of patients.

KEYWORDS:

• Active compression decompression
• automated chest compressor
• cardiac arrest
• cardiopulmonary resuscitation
• impedance threshold device
• ACLS

Article highlights

• Cardiovascular disease is rising and often leads to cardiac arrest and cardiopulmonary resuscitation, but despite great efforts in research, survival after cardiac arrest is still low.

• Medical adjunct devices for high-quality cardiopulmonary resuscitation show remarkable benefits in preclinical studies and clinical trials, yet their routine use is still not recommended by current guidelines.

• For a broad implementation of these devices, their true potential needs to be further investigated in combination with other life-saving treatments in the hospital (coronary interventions in the cardiac catheterization laboratory, ECMO) where these adjunct devices are the key for prolonged high-quality CPR during patient transport and the intervention.

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Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This work was supported, in part, by funding from a Merit Review Award (I01 BX003482) from the U.S. Department of Veterans Affairs Biomedical Laboratory R&D Service awarded to M Riess. C Balzer is funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) – Project number 397561247. Additional support provided by institutional funds and the National Institutes of Health (5R01 HL123227).