Comparison of Chest Compression Quality between Transfer Sheet and Stretcher Use for Transporting out-of-Hospital Cardiac Arrest Patients in a High-Rise Building - A Randomized and Open-Label Cross-over Design

Comparison of prehospital resuscitation quality during scene evacuation and early ambulance transport in out-of-hospital cardiac arrest between residential location and non-residential location

BACKGROUND

High-quality prehospital cardiopulmonary resuscitation (CPR) is important for out-of-hospital cardiac arrest (OHCA). We aimed to evaluate prehospital CPR quality during scene evacuation and early ambulance transport in patients with OHCA according to the type of cardiac arrest location.

METHODS

This retrospective observational cohort study enrolled patients with non-traumatic adult OHCA in Seoul between July 2020 and March 2022. Prehospital CPR quality data extracted from defibrillators were merged with the national OHCA database. The location of cardiac arrest was categorized into two groups (residential and non-residential). CPR quality indices including no-flow (any pause >1.5 s) fraction were compared according to the type of arrest location at each minute of EMS scene evacuation and early ambulance transport (5 min prior to 5 min after ambulance departure).

RESULTS

A total of 1,222 OHCAs were enrolled in the final analysis after serial exclusion. A total of 966 OHCAs (79.1%) occurred in the residential areas. The CPR quality deteriorated during the scene evacuation in both location type. The mean no-flow fractions were significantly higher in residential places than in non-residential places. The mean proportion of adequate compression depth and rate was lower in cardiac arrests in residential places. The discrepancy in EMS CPR quality during scene evacuation was more prominent when mechanical CPR devices were not used.

CONCLUSION

Deterioration of CPR quality was observed just before and during early ambulance transport, especially when the cardiac arrest location was a residential area or when only manual CPR was provided.

Efficacy of heads-up CPR compared to supine CPR positions: Systematic review and meta-analysis

Background and Aim

Cardiopulmonary resuscitation (CPR) in full-coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads-up CPR versus supine CPR.

Methods

We searched PubMed Central, SCOPUS, Web of Science, and Cochrane databases from 1990 to February 2021. After the full-text screening of 40 eligible studies, only seven studies were eligible for our meta-analysis. We used the RevMan software (5.4) to perform the meta-analysis.

Results

In survival outcome, the pooled analysis between heads-up and supine CPR was (risk ratio = 0.98, 95% confidence interval [CI] = 0.17-5.68, p = 0.98). The pooled analyses between heads-up CPR and supine CPR in cerebral flow, cerebral perfusion pressure and coronary perfusion pressure outcomes, were (mean difference [MD] = 0.10, 95% CI = 0.03-0.17, p = 0.003), (MD = 12.28, 95% CI = 5.92-18.64], p = 0.0002), and (MD = 8.43, 95% CI = 2.71-14.14, p = 0.004), respectively. After doing a subgroup analysis, cerebral perfusion was found to increase during heads-up CPR compared with supine CPR at 6 min CPR duration and 18 to 20 min CPR duration as well.

Conclusion

Our study suggests that heads-up CPR is associated with better cerebral and coronary perfusion compared to the conventional supine technique in pigs' models. However, more research is warranted to investigate the safety and efficacy of the heads-up technique on human beings and to determine the best angle for optimization of the technique results.

Cardiac Arrest Occurring in High-Rise Buildings: A Scoping Review

Out-of-hospital cardiac arrests (OHCAs) occurring in high-rise buildings are a challenge to Emergency Medical Services (EMS). Contemporary EMS guidelines lack specific recommendations for systems and practitioners regarding the approach to these patients. This scoping review aimed to map the body of literature pertaining to OHCAs in high-rise settings in order to clarify concepts and understanding and to identify knowledge gaps. Databases were searched from inception through to 6 May 2021 including OVID Medline, PubMed, Embase, CINAHL, and Scopus. Twenty-three articles were reviewed, comprising 8 manikin trials, 14 observational studies, and 1 mathematical modelling study. High-rise settings commonly have lower availability of bystanders and automatic external defibrillators (AEDs), while height constraints often lead to delays in EMS interventions and suboptimal cardiopulmonary resuscitation (CPR), scene access, and extrication. Four studies found return of spontaneous circulation (ROSC) rates to be significantly poorer, while seven studies found rates of survival-to-hospital discharge (n = 3) and neurologically favourable survival (n = 4) to be significantly lower in multistorey settings. Mechanical chest compression devices, transfer sheets, and strategic defibrillator placement were suggested as approaches to high-rise OHCA management. A shift to maximising on-scene treatment time, along with bundling novel prehospital interventions, could ameliorate some of these difficulties and improve clinical outcomes for patients.