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Mechanical devices for cardiac massage: must-have or luxury? 

Mechanical devices for cardiac massage: must-have or luxury?  . Giuseppe Biondi-Zoccai , MD Sapienza University of Rome , Italy giuseppe.biondizoccai@uniroma1.it. Learning goals. Why do we need mechanical devices for cardiac massage Which devices are available What are their pros

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Mechanical devices for cardiac massage: must-have or luxury? 

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  1. Mechanical devices for cardiac massage: must-have or luxury?  Giuseppe Biondi-Zoccai, MD Sapienza University ofRome, Italy giuseppe.biondizoccai@uniroma1.it

  2. Learninggoals • Why do weneedmechanicaldevicesforcardiac massage • Whichdevices are available • What are theirpros • What are theircons • Evidence • Case study

  3. Learninggoals • Why do weneedmechanicaldevicesforcardiac massage • Whichdevices are available • What are theirpros • What are theircons • Evidence • Case study

  4. The qualityofmanualchestcompressionisvariable, and when low isdeadly Abellaet al, Circulation 2005

  5. Manualchestcompressionmayneverbedoneadequately in selectedsettings

  6. Learninggoals • Why do weneedmechanicaldevicesforcardiac massage • Whichdevices are available • What are theirpros • What are theircons • Evidence • Case study

  7. Thumper (i.e. Life-Stat)

  8. Vest CPR

  9. AutoPulse

  10. AutoPulse

  11. LUCAS

  12. LUCAS

  13. CardioPump ACD-CPR

  14. CardioPump ACD-CPR

  15. Learninggoals • Why do weneedmechanicaldevicesforcardiac massage • Whichdevices are available • What are theirpros • What are theircons • Evidence • Case study

  16. Obviousadvantages

  17. Reliability and force Steenet al, Resuscitation 2002

  18. Reliability and force Cardiacarrest LUCAS Manualcompression Agostoni et al, Int J Cardiol 2008

  19. Compression and decompression Steenet al, Resuscitation 2002

  20. Learninggoals • Why do weneedmechanicaldevicesforcardiac massage • Whichdevices are available • What are theirpros • What are theircons • Evidence • Case study

  21. Trauma Larsenet al, Resuscitation 2007

  22. Coronarypressuremaybetoo low Larsenet al, Resuscitation 2010

  23. Defibrillationmaybedelayed Putzer et al, Am J EmergMed 2013

  24. Learninggoals • Why do weneedmechanicaldevicesforcardiac massage • Whichdevices are available • What are theirpros • What are theircons • Evidence • Case study

  25. Non-randomized trial Axelssonet al, Resuscitation 2006

  26. RCT ofAutoPulse Hallstromet al, JAMA 2006

  27. RCT ofCardioPump ACD-CPR and ITD Aufderheideet al, Lancet 2011

  28. Learninggoals • Why do weneedmechanicaldevicesforcardiac massage • Whichdevices are available • What are theirpros • What are theircons • Evidence • Case study

  29. Case study Age: 40 years Gender: male Comorbidities: type 1 diabetes mellitus Diagnosis: acute myocardial infarction Prehospital events/management: VF treated with DC shock, followed by PEA; manual chest compression, repeat IV adrenaline boluses, tracheal intubation, mechanical ventilation Hospital events/management: systemic thrombolysis with alteplase attempted without success; LUCAS deployment and transfer to the cath lab Biondi-Zoccaiet al, HSR Proc Intensive Care CardiovascAnesth2011

  30. Baselinecoronaryangiography Biondi-Zoccaiet al, HSR Proc Intensive Care CardiovascAnesth2011

  31. Predilation on leftmain-circumflex Biondi-Zoccaiet al, HSR Proc Intensive Care CardiovascAnesth2011

  32. Leftmain-anteriordescendingstenting Biondi-Zoccaiet al, HSR Proc Intensive Care CardiovascAnesth2011

  33. Coronaryangiographyafterstenting Biondi-Zoccaiet al, HSR Proc Intensive Care CardiovascAnesth2011

  34. Take home message • Despiteongoingresearchforseveraldecades, manualchestcompressionremains the gold standard meanstoperformcardiac massage. • Mechanicaldeviceshaveseveraladvantages in comparisontomanualchestcompression. • High-qualityevidenceisstilllacking and a selecteduseofthesedevicesis the safestapproachuntilongoingtrials (e.g. CIRC, LINC and PARAMEDIC) are complete.

  35. Manythanksforyourattention Fortheseslides and furtherones on similartopicsfeel free tovisit: www.metcardio.org/slides.html Foradditionaldetails or queriesfeel free tocontact me directly: giuseppe.biondizoccai@uniroma1.it

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