Adjuncts and Adjuncts and UpdateUpdate in CPR in CPRNalinas Khunkhlai, MD

Department of Emergency Medicine and Narenthorn EMS center,

Rajavithi hospital

Objective Objective

CPR Devices CPR Devices

Devices to Support CirculationDevices to Support Circulation

1. Active Compression-Decompression CPR

(ACD-CPR)

2. Impedance Threshold Device (ITD)

3. Mechanical Piston Device

4. Load-Distributing Band CPR (LDB-CPR)

or Vest CPR

5. Phased Thoracic-Abdominal

Compression-Decompression CPR (PTACD-

CPR)

Ref : Circulation Dec 2005 ; Guideline ACLS ECC

Lund University Cardiopulmonary Assist System (LUCAS)Lund University Cardiopulmonary Assist System (LUCAS)

1. Automatic mechanical compression 1. Automatic mechanical compression and active decompression resuscitationand active decompression resuscitation

Suction cup to actively lift the anterior chest during decompression..

To enhance venous return to the heart.

1. Automatic mechanical compression 1. Automatic mechanical compression and active decompression resuscitationand active decompression resuscitation

Lund University Cardiopulmonary Assist System (LUCAS)Lund University Cardiopulmonary Assist System (LUCAS)

Active Compression - DecompressionActive Compression - Decompression

2. Impedance Threshold Device2. Impedance Threshold Device

A valve to limit air entry into the lungs during chest recoil.

To reduce intrathoracic pressure And enhance venous return to the heart

ResQpodResQpod

2. Impedance Threshold Device2. Impedance Threshold Device

ResQpodResQpod

3.Mechanical Piston Device3.Mechanical Piston Device

Simultaneous Sterno-Thoracic Cardiopulmonary Resuscitation (SST-CPR)

Device depresses the sternum via

compressed gas-powered plunger

mounted on a backboard.

Simultaneous Simultaneous

Sterno-Thoracic Sterno-Thoracic

Cardiopulmonary Cardiopulmonary

Resuscitation (SST-CPR)Resuscitation (SST-CPR)

4.Load-Distributing Band CPR or Vest CPR4.Load-Distributing Band CPR or Vest CPR

Autopulse

5. Phase chest and abdominal compression-decompression5. Phase chest and abdominal compression-decompression

Combines the concepts of ACD-CPR

device and Interposed Abdominal

Compression-CPR technique

IAC-CPR : Interposed abdominal compression IAC-CPR : Interposed abdominal compression

Other Gadget for non-chest compression part : King LTOther Gadget for non-chest compression part : King LT

Other Gadget for non-chest compression : EtCO2 15-38 mmHg PCOOther Gadget for non-chest compression : EtCO2 15-38 mmHg PCO22

Other Gadget for non-chest compression partOther Gadget for non-chest compression part

Dent ER

Ohhhhh…..Ohhhhh…..

Jan 2008 : Jan 2008 :

Problem : Bystander CPR rates previously are too low

Recommendation :

1.Broaden CPR training ( Friend and Family CPR)

2.Reassurance (HIV not transmitted through performance of CPR.)

3.Improve EMS and CPR Quality

Mar 2008 : Hands-Only CPR Mar 2008 : Hands-Only CPR

Recommendation :

1.When adult sudden collapse, trained or

untrained bystanders should – at a

minimum – activate their community EMS

and provide at least hand-only CPR (Class

IIa)

2.CC-only : continue until the AED arrives

or EMS .

3.Bystander who’s not confident , provide

CC-only.

Apr 2008 : Essential feature of designating OHCAApr 2008 : Essential feature of designating OHCA

Oct 2008 : Hands-Only CPR Oct 2008 : Hands-Only CPR

Post-Cardiac Arrest Syndrome : Post-Cardiac Arrest Syndrome : Pathophysiology, Clinical manifestationPathophysiology, Clinical manifestation

Post-Cardiac Arrest Syndrome : Post-Cardiac Arrest Syndrome : Pathophysiology, Clinical manifestationPathophysiology, Clinical manifestation

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Thank you For your attention.