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Clinical Trial
. 2022 Oct;37(5):630-637.
doi: 10.1017/S1049023X22001042. Epub 2022 Jul 25.

Manual versus Mechanical Delivery of High-Quality Cardiopulmonary Resuscitation on a River-Based Fire Rescue Boat

Martin A C Manoukian  1 , Daniel J Tancredi  2 , Matthew T Linvill  1 , Elisabeth H Wynia  1 , Brianna Beaver  1 , John S Rose  1 , Bryn E Mumma  1
Affiliations
Clinical Trial

Manual versus Mechanical Delivery of High-Quality Cardiopulmonary Resuscitation on a River-Based Fire Rescue Boat

Martin A C Manoukian et al. Prehosp Disaster Med. 2022 Oct.

Abstract

Objectives: Studies have demonstrated the efficacy of mechanical devices at delivering high-quality cardiopulmonary resuscitation (HQ-CPR) in various transport settings. Herein, this study investigates the efficacy of manual and mechanical HQ-CPR delivery on a fire rescue boat.

Methods: A total of 15 active firefighter-paramedics were recruited for a prospective manikin-based trial. Each paramedic performed two minutes manual compression-only CPR while navigating on a river-based fire rescue boat. The boat was piloted in either a stable linear manner or dynamic S-turn manner to simulate obstacle avoidance. For each session of manual HQ-CPR, a session of mechanical HQ-CPR was also performed with a LUCAS 3 (Stryker; Kalamazoo, Michigan USA). A total of 60 sessions were completed. Parameters recorded included compression fraction (CF) and the percentage of compressions with correct depth >5cm (D%), correct rate 100-120 (R%), full release (FR%), and correct hand position (HP%). A composite HQ-CPR score was calculated as follows: ((D% + R% + FR% + HP%)/4) * CF%). Differences in magnitude of change seen in stable versus dynamic navigation within study conditions were evaluated with a Z-score calculation. Difficulty of HQ-CPR delivery was assessed utilizing the Borg Rating of Perceived Exertion Scale.

Results: Participants were mostly male and had a median experience of 20 years. Manual HQ-CPR delivered during stable navigation out-performed manual HQ-CPR delivered during dynamic navigation for composite score and trended towards superiority for FR% and R%. There was no difference seen for any measured variable when comparing mechanical HQ-CPR delivered during stable navigation versus dynamic navigation. Mechanical HQ-CPR out-performed manual HQ-CPR during both stable and dynamic navigation in terms of composite score, FR%, and R%. Z-score calculation demonstrated that manual HQ-CPR delivery was significantly more affected by drive style than mechanical HQ-CPR delivery in terms of composite HQ-CPR score and trended towards significance for FR% and R%. Borg Rating of Perceived Exertion was higher for manual CPR delivered during dynamic sessions than for stable sessions.

Conclusion: Mechanical HQ-CPR delivery is superior to manual HQ-CPR delivery during both stable and dynamic riverine navigation. Whereas manual HQ-CPR delivery was worse during dynamic transportation conditions compared to stable transport conditions, mechanical HQ-CPR delivery was unaffected by drive style. This suggests the utility of routine use of mechanical HQ-CPR devices in the riverine patient transport setting.

Keywords: cardiac arrest; high-quality cardiopulmonary resuscitation; mechanical CPR; prehospital care; river-based CPR.

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Figures

Figure 1.
Figure 1.
Rigid Hull Inflatable Vessel Used in Study.
Figure 2.
Figure 2.
Representative Schematic of Drive Course Undertaken in Stable Linear Study Conditions and Dynamic S-Turn Study Conditions.
Figure 3.
Figure 3.
Box and Whisker Plot of HQ-CPR Outcomes in the Four Study Conditions for Various HQ-CPR Measurements. Abbreviations: D%, percentage of compressions with correct depth >5cm; FR%, percentage of compressions with full chest release; R%, percentage of compressions with correct rate 100-120 compressions per minute; HP%, percentage of compressions with correct hand position; CF%, compression fraction; Composite %, final composite score as calculated by the equation ((D% + R% + FR% + HP%)/4) * CF%); HQ-CPR, high-quality cardiopulmonary resuscitation.
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References

    1. Meaney PA, Bobrow BJ, Mancini ME, et al. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013;128(4):417–435. - PubMed
    1. Malta Hansen C, Kragholm K, Pearson DA, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013. JAMA. 2015;314(3):255–264. - PubMed
    1. Nakahara S, Tomio J, Ichikawa M, et al. Association of bystander interventions with neurologically intact survival among patients with bystander-witnessed out-of-hospital cardiac arrest in Japan. JAMA. 2015;314(3):247–254. - PubMed
    1. Kleinman ME, Brennan EE, Goldberger ZD, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S414–435. - PubMed
    1. Fox J, Fiechter R, Gerstl P, et al. Mechanical versus manual chest compression CPR under ground ambulance transport conditions. Acute Card Care. 2013;15(1):1–6. - PubMed

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