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Chest compression machines - yes or no!!!
Chest Compression Device Improves Survival in Out-of-Hospital Cardiac
Arrest . . . or Does it
Two studies yield conflicting results on the benefits of an automated
load-distributing band used for chest compressions during CPR.
Many studies have shown wide variations in performance of cardiopulmonary
resuscitation and a clear relation between the quality of CPR and patient
outcome. In two recent studies, researchers tested the value of using a
noninvasive automated load-distributing band for chest compressions. The
band is applied directly around the sternum and by cyclical squeezing
reduces the anteroposterior diameter of the chest at the sternum by 20%.
In the first study, Ong and colleagues evaluated the effect of the device
on return of spontaneous circulation (ROSC) in 210 adults with nontraumatic
cardiac arrest in a single urban emergency medical services system from
2003 to 2005. They compared outcomes with those in 449 patients given
standard manual CPR from 2001 to 2003. The device-CPR group had a faster
response time than did the manual-CPR group (mean difference, 26 seconds)
and more EMS-witnessed arrests (18.7% vs. 12.6%), but the two cohorts were
otherwise comparable.
The device-CPR group, compared with the manual-CPR group, had significantly
higher rates of ROSC (34.5% vs. 20.2%), survival to hospital admission
(20.9% vs. 11.1%), and survival to hospital discharge (9.7% vs. 2.9%). At
hospital discharge, neurologic status was comparable in the two groups.
In the second study, a multicenter randomized trial funded by the
manufacturer of the device, Hallstrom and colleagues evaluated the effect
of the device on rates of survival to 4 hours after the 911 call. During
2004 and 2005, a total of 767 patients with nontraumatic out-of-hospital
cardiac arrest in the U.S. and Canada were randomized to CPR using manual
chest compression or the device. A planned interim analysis demonstrated no
difference in survival to 4 hours between the device-CPR and manual-CPR
groups (26.4% and 24.7%). Rates of survival to hospital discharge also did
not differ significantly between the two groups (5.8% and 9.9%,
respectively). At hospital discharge, significantly fewer patients in the
device-CPR group than in the manual-CPR group (3.1% vs. 7.5%) had cerebral
performance categories of 1 (alert and conscious) or 2 (conscious).
Comment: Nearly half a million people die from out-of-hospital cardiac
arrest each year in the U.S. Over the past four decades, various strategies
and devices have been used in attempts to improve the dismal 1%-8% rate of
survival to hospital discharge. The results of the Ong study are promising,
but the authors caution about the need for a large, prospective, randomized
trial in which rescuers are blinded to the intervention before they
initiate resuscitation. The Hallstrom study analyzed the same device and
found not only no benefit but worsening of some outcomes, prompting early

termination of the trial. Editorialists suggest that the trials'
contradictory results might result from differences in patient selection,
presenting rhythm, time from cardiac arrest to initial CPR, and time to
deployment of the device.
Of note, the manufacturer has promoted the device based in part on the
results obtained in the Ong study. To prevent the cart-before-the-horse
sagas of military antishock trousers and of methylprednisolone for blunt
spinal cord injury, this device's efficacy, or lack thereof, must be
established according to the highest scientific standards. Until that time,
enthusiasm for the device should be tempered.
-- John A. Marx, MD, FAAEM, FACEP
Citation(s): Ong MH et al. Use of an automated, load-distributing band
chest compression device for out-of-hospital cardiac arrest resuscitation.
JAMA 2006 Jun 14; 295:2629-37.
Hallstrom A et al. Manual chest compression vs use of an automated chest
compression device during resuscitation following out-of-hospital cardiac
arrest: A randomized trial. JAMA 2006 Jun 14; 295:2620-8.
Lewis RJ and Niemann JT. Manual vs device-assisted CPR: Reconciling
apparently contradictory results. JAMA 2006 Jun 14; 295:2661-4.
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