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NOTARZT 2019; 35(03): 169-176
DOI: 10.1055/a-0821-9054
Zusatzweiterbildung Notfallmedizin
Georg Thieme Verlag KG Stuttgart · New York

Automatische externe Reanimationsgeräte

The Use of Automated External Chest Compression Devices in Emergency Medical Services from a Forensic Perspective
Benjamin Ondruschka
,
Ronny Bayer
,
Michael Bernhard
,
Niels Hammer
,
Claas T. Buschmann
Further Information

Publication History

Publication Date:
11 June 2019 (online)

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Zusammenfassung

In der Reanimationssituation müssen die professionellen Helfer trotz hoher Stresslevel und Zeitknappheit schnell, ressourceneffizient und zielführend Entscheidungen im Sinne des Patienten treffen: grundlegend dabei ist etwa das Abwägen zwischen dem Einsatz einer automatischen externen Reanimationshilfe zur kontinuierlichen, gleichmäßigen und ermüdungsfreien Durchführung der Thoraxkompressionen bis zum Wiedererreichen eines Eigenkreislaufs oder dem Abbruch der Maßnahmen.

Abstract

The use of automated chest compression devices (ACCD) is more and more common in cardiac arrest, where cardiopulmonary resuscitation (CPR) gets necessary. However, its use is only recommended in complex and prolonged rescue situations. The routine and uncritical use should be avoided given the missing data for a higher survival rate or better neurological outcome for patients getting an ACCD and not only manual chest compressions (mCC). Iatrogenic injuries are commonly observed as a consequence of sufficient chest compression during CPR as well-known complications and are not avoidable for the medical staff. The severity of injuries did not differ between ACCD or mCC. However, no chest compression-associated injury registered was fatal for the individual in case of frustrating CPR given that other conditions were causative earlier for the cardiac arrest, but these injuries registered might influence the post-CPR interval in case of initial survival dramatically. Therefore, the authors recommend a standard work-up including a computed tomography scan of the chest and abdomen for CPR-associated injuries in the clinical routine after return of spontaneous circulation as soon as possible.

Kernaussagen

  • Die Anwendung von ACCD (Automated Chest Compression Device, mechanische Reanimationshilfe) zur kardiopulmonalen Reanimation (CPR) ist nur bei komplizierten und prolongierten Reanimationssituationen empfohlen.

  • Vom routinemäßigen und unkritischen Dauereinsatz von ACCD ist mangels Patientenbenefit abzusehen.

  • Reanimationsverletzungen müssen sowohl bei ACCD als auch mCC (manual Chest Compression, manuelle Thoraxkompression) in Kauf genommen werden und sind die Regel bei jedweder Form von suffizient durchgeführten Thoraxkompressionen.

  • Reanimationsverletzungen sind bei frustranem CPR-Verlauf regelhaft nicht die Todesursache, könnten bei primärem Überleben aber den Therapieverlauf wesentlich beeinflussen.

  • Deshalb ist bei erfolgreichem ROSC (Return of Spontaneous Circulation) ein Post-CPR-Evaluationsprotokoll inkl. zeitnahem Thorax- und Abdomen-CT in die Post-CPR-Versorgung zu integrieren.

Schlüsselwörter

automatische externe Reanimationsgeräte (ACCD) - kardiopulmonale Reanimation - LUCAS - Rechtsmedizin - Tod

Key words

automated chest compression device (ACCD) - cardiopulmonary resuscitation - LUCAS - legal medicine - death
 

  • Literatur

  • 1 Ondruschka B, Baier C, Bayer R. et al. Chest compression-associated injuries in cardiac arrest patients treated with manual chest compressions versus automated chest compression devices (LUCAS II) – a forensic autopsy-based comparison. Forensic Sci Med Pathol 2018; 14: 515-525
    CrossrefPubMedSearch in Google Scholar
  • 2 Smekal D, Johansson J, Huzevka T. et al. No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS™ device – A pilot study. Resuscitation 2009; 80: 1104-1107
    CrossrefPubMedSearch in Google Scholar
  • 3 Rubertsson S, Lindgren E, Smekal D. et al. Mechanical chest compression and simultaneous defibrillation vs. conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial. JAMA 2014; 311: 54-61
    PubMedSearch in Google Scholar
  • 4 Perkins GD, Lall R, Quinn T. et al. Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. Lancet 2015; 385: 947-955
    CrossrefPubMedSearch in Google Scholar
  • 5 Hallstrom A, Rea TD, Sayre MR. 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; 295: 2620-2628
    PubMedSearch in Google Scholar
  • 6 Wik L, Olsen JA, Persse D. et al. Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation 2014; 85: 741-748
    CrossrefPubMedSearch in Google Scholar
  • 7 Marti J, Hulme C, Ferreira Z. et al. The cost-effectiveness of a mechanical compression device in out-of-hospital cardiac arrest. Resuscitation 2017; 117: 1-7
    CrossrefPubMedSearch in Google Scholar
  • 8 Newberry R, Redman T, Ross E. et al. No benefit in neurologic outcomes of survivors of out-of-hospital cardiac arrest with mechanical compression device. Prehosp Emerg Care 2018; 22: 338-344
    CrossrefPubMedSearch in Google Scholar
  • 9 Majer J, Zwolinski P, Popielarska Z. et al. Comparison of chest compressions with and without LUCAS3 mechanical chest compression system during resuscitation performed by novice physicians. Post N Med 2018; 31: 322-327
    PubMedSearch in Google Scholar
  • 10 Koster RW, Beenen LF, van der Boom EB. et al. Safety of mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority. Eur Heart J 2017; 38: 3006-3013
    CrossrefPubMedSearch in Google Scholar
  • 11 Khan SU, Lone AN, Talluri S. et al. Efficacy and safety of mechanical versus manual compression in cardiac arrest – A Bayesian network meta-analysis. Resuscitation 2018; 130: 182-188
    CrossrefPubMedSearch in Google Scholar
  • 12 Smekal D, Lindgren E, Sandler H. et al. CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device: A multicenter study of victims after unsuccessful resuscitation. Resuscitation 2014; 85: 1706-1712
    PubMedSearch in Google Scholar
  • 13 Lardi C, Egger C, Larribau R. et al. Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS™2): a forensic autopsy study. Int J Legal Med 2015; 129: 1035-1042
    CrossrefPubMedSearch in Google Scholar
  • 14 Baubin M, Rabl W, Pfeiffer KF. et al. Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers. Resuscitation 1999; 43: 9-15
    CrossrefPubMedSearch in Google Scholar
  • 15 Ondruschka B, Baier C, Hartwig T. et al. Leitlinienadhärenz bei frustran verlaufenden Reanimationen mit automatischen Reanimationsgeräten. Notarzt 2018; 35: 247-253
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Treffer D, Monschau S, Helm M et al. Mechanische Thoraxkompressionsgeräte. Notfallmed up2date 2018; 13: 125-130
    PubMedSearch in Google Scholar
  • 17 Soar J, Nolan JP, Böttiger BE. et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2015; 95: 100-147
    CrossrefPubMedSearch in Google Scholar
  • 18 Truhlar A, Deakin CD, Soar J. et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95: 148-201
    CrossrefPubMedSearch in Google Scholar
  • 19 Wang PL, Brooks SC. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev 2018; (08) CD007260
    PubMedSearch in Google Scholar
  • 20 Bernhard M, Behrens NH, Wnent J. et al. Out-of-hospital airway management during manual compressions vs. automated chest compression devices: a registry-based analysis. Anästhesist 2018; 67: 109-117
    CrossrefPubMedSearch in Google Scholar
  • 21 Meaney PA, Bobrow BJ, Mancini ME. et al. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation 2013; 128: 417-435
    CrossrefPubMedSearch in Google Scholar
  • 22 Bratzke H. Tote haben keine Lobby – Anmerkungen zum „Lazarus-Phänomen“. Anästhesist 2010; 59: 293-294
    CrossrefPubMedSearch in Google Scholar
  • 23 Ondruschka B, Hädrich C. Die ärztliche Leichenschau. Notfallmed up2date 2014; 9: 196-201
    PubMedSearch in Google Scholar
  • 24 Maxeiner H. Congestion bleedings of the face and cardiopulmonary resuscitation – an attempt to evaluate their relationship. Forensic Sci Int 2001; 117: 191-198
    CrossrefPubMedSearch in Google Scholar
  • 25 Hashimoto Y, Moriya F, Furumiya J. Forensic aspects of complications resulting from cardiopulmonary resuscitation. Legal Med 2007; 9: 94-99
    CrossrefPubMedSearch in Google Scholar
  • 26 Maxeiner H, Jekat R. Resuscitation and conjunctival petechial hemorrhages. J Forensic Leg Med 2010; 17: 87-91
    CrossrefPubMedSearch in Google Scholar
  • 27 Ondruschka B, Baier C, Bernhard M. et al. Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation. Forensic Sci Med Pathol 2019; 15: 48-55
    CrossrefPubMedSearch in Google Scholar
  • 28 Buschmann C, Tsokos M. Frequent and rare complications of resuscitation attempts. Intens Care Med 2009; 35: 397-404
    CrossrefPubMedSearch in Google Scholar
  • 29 Ondruschka B, Hartwig T, Gries A. et al. Perikardlazeration nach Verwendung einer automatischen externen Reanimationshilfe. Notfall Rettungsmed 2017; 20: 424-429
    CrossrefPubMedSearch in Google Scholar
  • 30 Buschmann C, Tsokos M. Iatrogene Traumata nach frustraner Reanimation. Notarzt 2008; 24: 197-202
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Bernhard M, Becker TK, Hossfeld B. Should we resuscitate or not – that is the question. J Thorac Dis 2016; 8: 1053-1056
    CrossrefPubMedSearch in Google Scholar
  • 32 Chelly J, Mongardon N, Dumas F. et al. Benefit of an early and systematic imaging procedure after cardiac arrest: insights from the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) registry. Resuscitation 2012; 83: 1444-1450
    CrossrefPubMedSearch in Google Scholar
  • 33 Schröder R, Hädrich C. Assoziierte Verletzungen bei Nutzung automatischer Reanimationshilfen – wirklich ein Problem?. Intensiv Notfallbehandl 2015; 40: 33-34
    PubMedSearch in Google Scholar