Swanson M et al. Circulation 200 Swanson M et al. Circulation 20 5 (Florida)

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1 Bryssmask kiner i AHLR: Flopp - eller kanskje en bro til PCI? Kristian Lexow, overlege Leder, NRR Flow-studier Dyreeksperimentelle studier Case reports Kliniske studier på overlevelse Feasibility studier

2 Swanson M et al. Circulation (Florida) Effect of a CPR assist device (Auto opulse) on survival to Emergency Department arrival in out of hospita al cardiac arrest Manual N=405 AutoPulse N=118 Survival to ED (all) Survival to ED (VF) Survival to ED (PEA) Survival to ED (Asystoli) - Non randomized study - Retrospective study - Guidelines % 33% 17% 10% 29% 31% 32% 24% End point: Survival to ED arrival ( not survival to discharge ) p

3 Casner et al. Prehosp Emerg Car re 2005 (San Fracisco) The impact of a new CPR assist de evice on rate of return of spontaneous circulation in out of ho ospital cardiac arrest. Manual Autopulse p N=93 N=69 ROSC (all) ROSC (VF) ROSC (PEA) ROSC (Asystoli) - Historiske kontroller 29% 50% 23% 22% 39% 44% 38% 37% 0, ,079 0,008 - Endepunkt: ROSC (ikke survival to discharge )

4 Stig Steen et al. Resuscitation 2005: Treatment of out-of of- hospital cardiac arrest with LUCA AS, a new device for automatic mechanical compression and ac ctive decompression resuscitation ti

5 Axelsson et al. Resuscitation Evaluation of LUCAS Manual N=169 ROSC Admitted Hosp Discharged alive Konklusjon: Ingen forskjell LUCAS N= % 51 % 37 % 38 % 10 % 8 %

6 Ong ME (Ornato JP) et al. JAMA A 2006 Use of an automated, load-distribu distribu uting band chest compression device for out-of-hospital cardiac arrest resuscitation Manual Autopulse p N=499 N=284 EMS witnessed 13% 19% ROSC 20% 35% Admitted Hospital 10% 21% Discharged alive 3% 11%

7 Ong ME (Ornato JP) et al. JAMA 2006 Innvendinger - Bare 210 av de 284 (74,2%) i mekanisk gruppe fikk beh. med Autopulse. Grunn: De fleste av de resterende i mekanisk gruppe fikk ROSC før Autpulse ble satt på. - Retrospektiv studie - Autopulsegruppen hadde raskere responstid enn manuell-gruppen (mean 26 sek. raskere) - Autopulsegruppen hadde høyere rate EMS-witnessed arrest (19% vs 13%) - Ingen forskjell i nevrologisk utkom mme

8 Hallstrom et al. JAMA 2006 (Mu lticenter USA) Assisted Prehospital International Resuscitation Trial (ASPIRE) All: Survival to 4 hours Manual N= 517 Autopulse N= 554 All: Survival to discharge AS: Survival to 4 hours AS: Survival to discharge VF: survival to 4 hours VF: Survival to discharge Neurological intact (1-2) 10% 10% 0% 35% 17% 7% 6% 17% 1.8% 34% 9% 3,8% 0, ,0 0, Suspended after enrolling 1071 of planned 1837 pat. Dårligere nevrologisk utkomme ved bruk av Autopulse P 25% 26% 0,62

9 Krep et al. Resuscitation 2007 (B Bonn) Out-of-hospital CPR with the Autop pulse system: A prospective observational study with a new load d-distributing distributing band chest compression device ROSC Admitted to ED vith ROSC Discharged alive Autopulse N=46 25 (54%) 18 (39%) 10 (22%)

10 Kritiske faktorer for studier av m ekanisk brys - Beskrive trening av mannskapenee - Beskrive inklusjons- og eksklusjonskriterier - Beskrive responstid (alarm til start HLR) - Beskrive e tid fra ankomst pas. til montering av kompresjonsmaskin - Beskrive medgått tid til å montere kompresjonsmaskinen på pasient - Beskrive endepunkt for studien -ROSC - Alive at arrival ED - Alive at discharge - Alive after 30 D - Beskrive nevrologisk utkomme

11 - in hospital Sunde. Crit Care Med 2008 Experimental and clinical use of on going mechanical cardiopulmonary resuscitation during angiography an nd PCI Objective To review the literature with the aim of documenting if coronary angiography and subsequent PCI is feasible during continuous mechanical chest compressions. Conclusions Coronary angiography and PCI is feasible during continuous mechanical chest compressions. This could be an alternative approa ach in cardiac arrest patients with suspected MI who do not achieve ROSC with traditional resuscitation techniques.

12 - in hospital Marko N, Radsel P. Current Opini on in Critical Care 2008 Urgent invasive i coronary strategy t in patients t with sudden cardiac arrest Objective To review the evidence on urgent coronary angiography g and PCI after resuscitated cardiac arrest and during ongoing CPR. Summary PCI is feasible in patients undergoin ng CPR. In 34 reported patients, the success rate of PCI was 88% and su urvival to hospital discharge 41%. - Manually CPR: 12 pat. (35%) - Mechanical chest compression: 1 6 pat. (47%) (13 fra SUS) Conclusion Urgent PCI may be attempted during ongoing CPR in selected patients. It should probably be centralized to dedicated 24/7 PCI centers with well equipped and skilled catheterization laboratory and intensive care units.

13 k kompresjon Mulige indikasjoner i dag Alle tilfeller av prehospital hjertestans Alle med bevitnet prehospital hjertestans Alle med bevitnet prehospital hjertestans funnet i VF Alle dypt hypoterme der AHLR er indisert Pas. med stans etter strømskade/lynnedsslag Intokspasienter med stans Som en bro til PCI for utvalgte pasienter Hvis HLR er indisert under transport Hvis HLR er indisert under PCI Nei Nei Nei Noen ganger Noen ganger Noen ganger g Kanskje Ja Ja Ja