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ZOLL AutoPulse ®

ZOLL AutoPulse ®. Non-invasive Cardiac Support Pump. ZOLL AutoPulse ®. ZOLL’s History. 1952 Dr Paul Zoll first to successfully pace human 1956 Dr Paul Zoll first to successful externally defibrillate patient 1988 PD 1200 Pacemaker/Defibrillator/Monitor brought to market

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ZOLL AutoPulse ®

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  1. ZOLL AutoPulse® Non-invasive Cardiac Support Pump

  2. ZOLL AutoPulse®

  3. ZOLL’s History 1952 Dr Paul Zoll first to successfully pace human 1956 Dr Paul Zoll first to successful externally defibrillate patient 1988 PD 1200 Pacemaker/Defibrillator/Monitor brought to market 1995 M Series Introduced – First fully integrated Shockable Rhythm Interpretation (Advisory) Pacemaker/Defibrillator/Monitor 1997 RescueNet – first integrated data system for EMS developed 2002 First CPR Guidance System developed with the AED Plus 2004 Revivant Corporation acquired – adding the AutoPulse Manual CPR device to the product offering

  4. ZOLL AutoPulse® • Automatic • Portable • Non-invasive • Battery Operated

  5. Manual CPR Conventional CPR provides less than optimal blood flow to the heart and brain 10% - 20% of normal flow 30% - 40% of normal flow Kern KB Bailliere’s Clinical Anaesthesiology. 2000;14(3):591-609.

  6. The Solution – AutoPulse Solution: The AutoPulse • A well perfused myocardium is more likely to experience ROSC • Paradis et al found that a minimum of 15 mmHg was required to achieve ROSC • Manual CPR, on average achieves 12.5 mmHg • Levels of ROSC increase with CPP in prolonged cardiac arrest. • AutoPulse provides upwards of 25 mmHg of CPP • At >25 mmHg of CPP, ROSC rates are at 79%

  7. ZOLL AutoPulse® • Uninterrupted compressions • Consistent rate & depth • User friendly • Suitable for emergency department • Superior Coronary Perfusion Pressure (CPP) compared with conventional CPR during resuscitation

  8. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  9. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  10. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  11. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  12. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  13. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  14. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  15. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  16. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  17. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  18. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  19. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  20. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  21. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  22. Operating Rational Uni-Directional Manual CPR Circumferential AutoPulse CPR

  23. Presenting Cardiac Rhythms Studies show that VF or VT is the initial rhythm less than 50% of the time Peberdy MA, Kaye W et al. Resuscitation 2003;58:297-308. Kaye W et al. Journal of the American College of Cardiology. 2002:39(5), Suppl A. Cobb L et al. JAMA. 2002; 288(23):3008-3013.

  24. Presenting Cardiac Rhythms • Defibrillation is only required in less than 50% of cases. • Quality CPR is required in 100% of cases!

  25. Manual CPR • Does not adequately perfuse the brain or heart

  26. Manual CPR • Does not adequately perfuse the brain or heart Manual CPR delivers • Inconsistent compressions • Fatigue • Pausing to rotate staff • Pausing to move the patient • OH&S Issues

  27. Manual CPR v AutoPulse Manual CPR AutoPulse CPR

  28. AutoPulse - Consistent Compressions

  29. Clinical Evidence Summary…

  30. Clinical Evidence – Manual CPR • Manual CPR is variable at best, even when performed by trained professionals – Abella et al, Wik et al • Effective CPR, with minimal interruptions, improves probability of successful defibrillation – Sato et al, Ikeno et al • Effective CPR is more important than the timing of defibrillation in achieving ROSC – Ristagno, et al

  31. Clinical Evidence - CPP • CPP is the best predictor of ROSC in prolonged cardiac arrests • ROSC does not occur in patients where CPP is below 15mmHg • Manual CPR achieves 12.5mm Hg on average – Paradis et al • CPP is improved with AutoPulse over manual CPR. – Timmerman et al

  32. Timerman S et al. Resuscitation.2004;61:273-280 CPP drops quickly when AutoPulse compressions stop CPP returns after several AutoPulse compressions AutoPulse Manual CPR AutoPulse

  33. Clinical Evidence - ROSC • AutoPulse provides pre arrest blood flow levels to heart and brain - Halperin et al • AutoPulse provides superior levels of ROSC and survival when compared to manual CPR – Ong et al • AutoPulse provides superior levels of ROSC and survival when compared to piston driven automated CPR – Ikeno et al

  34. Clinical Evidence - ROSC • AutoPulse provides superior levels of neurological function when compared to both manual and piston driven CPR – Ong et al, Ikeno et al

  35. Clinical Review

  36. Abella et al JAMA.2005;293:305-310 • University of Chicago Hospital • 67 Patients • Evaluated Quality of manual CPR in first 5 mins of code • Found that even in highly trained professionals CPR was: • too shallow, • too slow • ventilation occurred too frequently.

  37. Wik et al JAMA.2005;293:305-310 • Multi-location Emergency Services human study (Stockholm, London, Akershus) • Evaluated Quality of manual CPR in first 5 mins of arrest of 176 patients • 49% of time of code, patients did not receive CPR • With adjustment for defibrillation analysis, 42% time of code, patients did not receive CPR

  38. Wik et al JAMA.2005;293:305-310 • 59% of compressions were too shallow • Found high compression rates • Decreased cardiac output • Not enough time for proper venous return to heart • CPR performed by people is significantly different to guidelines

  39. Sato et al. Critical Care Medicine.1997;25:733-736 • Rodent study of 25 subjects put into VF • 4 minutes later defibrillation commenced • animals were grouped into 0, 10, 20, 30 and 40 s delays in between defibrillation and cessation of CPR • No animals that received more than 10 s delay in defibrillation survived more than 24 hours. • Resuscitation and survival rates lessened as delay increased

  40. Ristagno et al. Chest.2007;132:70-75 • Porcine study of 24 subjects put into VF • 5 minutes later treatment commenced • 4 randomized groups • Optimal CPR with early defibrillation • Optimal CPR with 3 minutes of CPR first • Conventional CPR* with early defibrillation • Conventional CPR* with 3 minutes of CPR first * Simulated by 25% that compression required to give 15 mm Hg CPP.

  41. Ristagno et al. Chest.2007;132:70-75 • All 12 subjects that were given optimal CPR achieved ROSC • Only 2 of the 12 subjects (16.6%) that were given conventional CPR achieved ROSC and those were shocked first • All surviving animals achieved full neurological recovery

  42. Paradis NA et al. JAMA. 1990;263:1106-1113 • Coronary Perfusion Pressure < 15 mmHg does not achieve Return of Spontaneous Circulation Conventional CPR mean CPP = 12.5 mmHg

  43. Timerman S et al. Resuscitation.2004;61:273-280 • 16 terminal patients • In-hospital cardiac arrest • 10 minutes of failed advanced care life support • Catheters were placed in the thoracic aorta and right atrium to measure CPP and peak aortic pressure • AutoPulse and Manual Compressions were alternated for 90 seconds each • Average time between arrest and the start of experiment was 30 (+/-5) minutes

  44. Timerman S et al. Resuscitation.2004;61:273-280 CPP drops quickly when AutoPulse compressions stop CPP returns after several AutoPulse compressions AutoPulse Manual CPR AutoPulse

  45. Timerman S et al. Resuscitation.2004;61:273-280 Results: AutoPulse-generated Coronary Perfusion Pressure (CPP) was 33% better than manual CPR

  46. Halperin et al. JAMA. 2006;295:2629-2637 • Porcine Study of 20 subjects @ John Hopkins • VF induced for 1 minute • Treated with conventional CPR (“The Thumper”) or the AutoPulse • Two arms of study • “BLS” scenario – no epinephrine • “ALS” scenario – with epinephrine

  47. Halperin et al. JAMA. 2006;295:2629-2637 Results: AutoPulse produced pre-arrest levels of blood flow to the heart and brain (ACLS protocol – with epinephrine)

  48. Ong et al. JAMA. 2006;295:2629-2637 • Study conducted by Richmond Fire Department of almost 800 patients • Overall improvement of ROSC (70.8%), survival to hospital admission (88%) and survival to discharge (234%).

  49. Ong et al. JAMA. 2006;295:2629-2637 • Improvement occurred regardless of initial cardiac rhythm • VF/VT • Asystole* • PEA* • Particularly where VF was initial rhythm or where the patient had a witnessed arrest or received bystander CPR until the AutoPulse was applied. * Small sample sizes

  50. Ikeno et al. Resuscitation. 2006;68:109-118 • Porcine Study with 56 subjects • 22 in AutoPulse, 22 using “the thumper” at 20% compression, 12 at 30% compression • VF induced for 4 minutes before treatment • All subjects that achieved ROSC, survived for 72 hours • Of the thumper subjects, none survived 20% compression (simulating manual CPR), even with adrenaline administered

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