Swimming against the mCPR tide…

I like it when people agree with me.  Most people do.  Sadly, I sometimes don’t have a lot of luck on that front, especially when it comes to mechanical CPR (mCPR), or when I suggest to my wife that we should by a Rocket Mustang (for her that is, I’m not a petrol head)

Most people know I am a sceptic when it comes to mCPR (which is probably the nice way of putting it).  I’ve tried to go along with the crowd and get on board with the mCPR craze, but then I do clinical case review, and I go back to my curmudgeonly ways.  I do actually believe that there are situations when it is a good idea to strap someone onto a granny-smasher and head off to hospital.  I just think they are relatively rare, and I don’t think mCPR should be used as a matter of routine in cardiac arrest, as the data doesn’t support that approach.(1)

I also think, that if mCPR is to be used, it should be used only after a good attempt at traditional resuscitation has been attempted, with high quality human powered (or even firefighter powered) CPR and appropriate interventions performed.  This is not how I see it being used where I work: it is slapped on everyone, from 4 day old corpses, to the old guy who was just having a snooze in the sun at the local park.  I know this is not a mCPR problem per se, but I wonder if the lack of investment (i.e. having to get on our knees and do some work) makes it more likely for people to crack on, when cracking on is the last thing that is needed.  I don’t know, but whatever it is, it embarrases me sometimes.  However, it is abundantly clear that people can do good CPR with minimal peri-shock pauses, and good compression ratios even in prolonged arrests(2), all without stopping CPR to manhandle a dead-weight patient and a machine (which takes longer than we think it does) (3)

Therefore, if we do genuinely want to resuscitate someone, it seems perverse to me that we would interrupt what we know works, to use what we know doesn’t, as a matter of routine.  Fortunately, I have found someone who agrees with me finally, and the best thing is, it’s someone far smarter than me!  Brilliant!

In all seriousness though, head over to ECGMedicalTraining.com to hear Tom Bouthillet talk about mCPR.  It’s a very considered talk, with a sensible approach to the pros and cons of mCPR.  It also makes me happy to know I’m not swimming against the tide all on my own.  It gets lonely outside of the echo chamber sometimes!

 

1.  Li, H., Wang, D., Yu, Y., Zhao, X., & Jing, X. (2016). Mechanical versus manual chest compressions for cardiac arrest: a systematic review and meta-analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24(1). https://doi.org/10.1186/s13049-016-0202-y
2.  Zeiner, S., Sulzgruber, P., Datler, P., Keferböck, M., Poppe, M., Lobmeyr, E., … Sterz, F. (2015). Mechanical chest compression does not seem to improve outcome after out-of hospital cardiac arrest. A single center observational trial. Resuscitation, 96, 220–225. https://doi.org/10.1016/j.resuscitation.2015.07.051
3.  Yost, D., Phillips, R. H., Gonzales, L., Lick, C. J., Satterlee, P., Levy, M., … Chapman, F. W. (2012). Assessment of CPR interruptions from transthoracic impedance during use of the LUCASTM mechanical chest compression system. Resuscitation, 83(8), 961–965. https://doi.org/10.1016/j.resuscitation.2012.01.019

 

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3 Responses to Swimming against the mCPR tide…

  1. Pingback: Swimming against the mCPR tide… — AmboFOAM | Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds

  2. Alex says:

    I’m surprised to hear this. Where I work (in the UK), we only use mCPR if we’re planning to transport the patient whilst in cardiac arrest, and that doesn’t happen very often… (We’d generally transport VF after the 4th shock or narrow complex PEA that isn’t producing a ROSC after 3-4 cycles; or situations like hypothermia or overdose where prolonged resus is indicated.)

    The evidence is pretty clear on this one.

    • Thanks for the comment Alex.
      What you describe is pretty much exactly where I think that mCPR has a place – exceptional circumstances where more needs to be done for a patient who should be a survivor, or where there are limited people (or firefighters) available. This is not the setting where I work, so I’m puzzled by the enthusiasm with which it is used.

      One of the reasons for mCPR being so popular (I am told) is for paramedic health and safety: it is easier to use mCPR than to do people/firefighter powered CPR and this results in less back injuries. So I am told. I have no way of verifying this, however it seems a little odd to me.

      ***WARNING! ANECDOTE AHEAD***
      In all my years as an ambulance officer, I have never seen, nor heard of, someone injuring themselves doing CPR (although I do know people who have found CPR taxing due to pre-existing injury).
      I do know many people (myself included) who have had injuries from manual handling – carting heavy stuff around. Certainly the data available both internally, and in published literature would suggest that this is the biggest risk.
      Nonetheless, there could be something in this, but I have no data to support or refute the assertion that mCPR is safer for paramedics.

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