Abstract P54: Interruptions To CPR When Applying A Load Distributing Band Cardiopulmonary Resuscitation Device In Patients Presenting With Cardiac Arrest To The Emergency Department
Aims: To compare interruptions to CPR and quality of CPR measures, before and after an Emergency Department (ED) switched from manual to load-distributing band (LDB) CPR. Primary outcome measures no-flow time and no-flow ratio during the first 5 minutes of resuscitation.
Methods: Phased, observational cohort evaluation of all out-of-hospital, non-traumatic cardiac arrest patients at a tertiary hospital ED. We collected continuous video data as well as chest compression data using the Physiocontrol LifePak12 Codestat Suite 7.0 for all resuscitations during the period just before and after adoption of LDB CPR.
Results: From Feb 2007-July 2008 there were 23 manual and 29 LDB cases. Patients in both phases were comparable in terms of age, gender, ethnicity, pre-existing medical history, witnessed arrest, arrest location, bystander CPR rates, prehospital defibrillation, initial rhythm and ED defibrillation. The No Flow Time (NFT), defined as the sum of all pauses between compressions longer than 1.5seconds, during the first 5 minutes of resuscitation was Manual CPR 76.3s vs LDB 135.9s (p<0.001). The No Flow Ratio (NFR), defined as NFT divided by segment length was Manual 0.25 vs LDB 0.45 (p<0.001). However from 5–10 mins into the resuscitation, NFT was Manual 102.1s vs LDB 81.0s (p=0.24) and NFR Manual 0.34 vs LDB 0.27 (p0.26). The average time to apply LDB CPR during this period was 169s. There was no statistical difference in ROSC Manual CPR 30.40% vs. LDB 41.40 % (p=0.42), survival to admission Manual 21.70% vs. LDB 34.50% (p=0.31), survival to 48h Manual 22.20% vs. 77.80% (p=0.26) although the study was not powered to detect a difference in survival.
Conclusion: Interruptions to CPR are an important consideration when using LDB CPR for cardiac arrest victims, especially during the first 5 minutes of resuscitation. Attention to team training and rapid application of the device to minimize interruptions is recommended.