The Development of Innovative Handheld Devices to Augment Cardiopulmonary Resuscitation Therapy and External Cardioversion and Defibrillation

Abstract

Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) devices were conceived and invented by Drs. Todd Cohen and Keith Lurie to improve the low survival rates for conventional CPR. Active decompression creates greater chest recoil as compared with the passive decompression used in standard CPR, leading to increased preload and greater cardiac output. ACD CPR devices use a suction cup to adhere themselves to the patient's chest. Putting downward force onto the device allows for the operator to actively compress the chest. Active chest decompression is achieved by pulling up on the device (using its suction), which in turn pulls up on the patient's chest, enabling greater chest expansion. Animal and human studies have demonstrated an improvement in overall circulation when using ACD CPR versus standard CPR. The impedance threshold device (ITD) was created to enhance ACD CPR. This device connects to the patient's airway and prevents the influx of air during chest decompression. ACD CPR plus ITD improves myocardial and cerebral perfusion, increases survival rates, and is associated with more favorable neurological outcomes. CPR guidelines permit the use of the above two devices by properly trained personnel. Additionally, an insulated handheld compression device can be actively applied over a standard defibrillation patch to decrease transthoracic impedance. This methodology has been incorporated into a patented PrestoPush^™ device (Nexus Control Systems LLC, Port Washington, NY, USA), which is a handheld external cardioversion/defibrillation augmenter. This paper reviews the development of these innovative devices to augment standard CPR and external cardioversion and defibrillation, including summaries of studies the authors consider to those that are most significant in ACD CPR development.

Keywords: Active compression-decompression; cardiopulmonary resuscitation; cardioversion; defibrillation; impedance threshold device.

Figure 1:

A: The first ACD CPR device used in human trials, manufactured by AMBU Inc. (Copenhagen, Denmark). B: The ACD CPR device known as the CardioPump^® (AMBU Inc., Copenhagen, Denmark). C: The ACD CPR device known as the ResQPump^® (Zoll Medical Corp., Chelmsford, MA, USA).

Figure 2:

The impedance threshold device known as the ResQPod^®, initially manufactured by Advanced Circulatory Systems Inc. (Roseville, MN, USA), and now manufactured by Zoll Medical Corp. (Chelmsford, MA, USA).

Figure 3:

The LUCAS^® 3 (Physio-Control, Inc., Redmond, WA), a mechanical ACD CPR device. Photo courtesy of Physio-Control, Inc. ACD: active compression-decompression; CPR: cardiopulmonary resuscitation.

Figure 4:

An example of ACD² in which a defibrillation patch is placed under the ACD CPR device.

Figure 5:

The PrestoPush^™ (Nexus Control Systems LLC, Port Washington, NY, USA) is a handheld device designed to improve the efficacy of external cardioversion and defibrillation. Image reprinted with permission from: Cohen TC, eds. Practical Electrophysiology. 3rd ed. Malvern, PA: HMP Communications; 2016: 17-171.

Figure 6:

The PrestoPatch^™ (Nexus Control Systems LLC, Port Washington, NY, USA) consists of an arrangement of three defibrillation patches and a high-voltage switch. Large image reprinted with permission from: Cohen TC, eds. Practical Electrophysiology. 3rd ed. Malvern, PA: HMP Communications; 2016: 17-171. The lower left corner insert shows the switch box, which connects to the three-patch system to provide shocks. Insert image added courtesy of Nexus Control Systems, LLC.