2004-4073b1_02_clinical history of cardiopulmonary resuscitation

8/2/2019 2004-4073b1_02_Clinical History of Cardiopulmonary Resuscitation

1/13


2/13

2

Several Goals

1. To address important issues in clinical

trial design for new CPR devices

2. To provide a clinical summary of the

history of CPR and devices to assist

with #1


3/13

3

Chain of Survival

Rapid Access

Cardiopulmonary resuscitation

Early Defibrillation

Advanced cardiopulmonary life support


4/13

4

The Beginnings of CPR

Resuscitation of arrest patients has

been attempted for over a century

In the 1950s, Safar et al and Elam et al

rediscovered mouth to mouth

In 1960, Kouwenhoven described chest

compression

These two techniques form the critical

steps of modern CPR


5/13

5

In-hospital Cardiac Arrest

Essentially unchanged over the last

three to four decades

Return of spontaneous circulation

(ROSC) in about 30% of patients

Approximately 15% of patients are

discharged neurologically intact


6/13

6

Interposed Abdominal

Counterpulsation14

0

10

20

30

40

50

60

ROSC Hosp D/C Intact

Neuro

IAC

S-CPR

%

occurrence

P=0.007

P=0.02

P=NS


7/13

7

Out-of-hospital Arrest

Hospital admission rates of 8-22%

Survival to discharge with intactneurologic function 1-8%

Largely unchanged despite multipleadditions to the basic components of

CPR


8/13

8

No Long Term Benefit

High dose epinephrine Short term improvement (ROSC, hospital

admission) 17

No long term improvement (hospital dischargeand neurologic function) 17,18,19

Vest CPR20

Trend towards increased rate of ROSC and 24hour survival but no difference in rate of hospital

discharge Transcutaneous pacing21

No improvement in rates of hospital admission ordischarge


9/13

9

Active-Compression

Decompression

Several studies found no improvement22,23

Another study24 comparing ACD-CPR to S-CPR

found improvement in several endpoints

0

5

1015

20

25

30

35

4045

ROSC 24 Hr Intact

Neuro Fx

ACD-CPR

S-CPR

%

occurrence

P=0.0004

P=0.002

P=0.03


10/13

10

Combination devices

Inspiratory impedance threshold devicescombined with ACD-CPR26,27

0

510

15

20

25

30

35

40

24 Hr Hosp

D/C

24 Hr Hosp

D/C

ACD-CPR+ ITD

S-CPR%

occurrence

P=0.033

P=0.41

P=0.02

P=0.63


11/13

11

Automatic External

Defibrillators28,29

0

10

20

30

40

50

60

Hosp D/C Intact Neuro Fx

all arrest

VF arrest%

occurrence


12/13

12

Public Access Defibrillation30

0

5

10

15

20

25

AED + CPR S-CPR

Survival to Hosp D/C

P=0.03


13/13

13

Summary

Survival rates with intact neurologic function

have changed little over the past 30-40 years

Choosing appropriate endpoints for clinicaltrials will be important to determine which

devices will facilitate improvement in long-

term outcomes

Fostering an environment to enhance clinical

research in this field will be important

2004-4073b1_02_clinical history of cardiopulmonary resuscitation

Documents