History of Mechanical Chest Compression Devices

Sternal compression in the absence of breathing and carotid pulse was first recorded in 1868 by John Hill. His description of how to perform a chest compression is still the basis of what is performed today. However, there was a lack of understanding and clarity as to the benefit of Sternal compressions. Any successful resuscitations attempts were attributed to the ammonia that was also placed over the patient’s nostrils and not to this intervention (Hunt, 2005).

Sternal compression was not adopted by the medical profession until 1960 when Peter Safar (pictured below), published his landmark paper, Cardiopulmonary Resuscitation (CPR). Safar was also the first person to see the importance for public education in CPR and co-developed the, now famous, Resusci Anne. He did invent the ventilation or ‘mouth-to-mouth’ section of CPR but he was not credited with the re-discovery of sternal compressions (Acierno and Worrell, 2007).

As a surgeon, Moritz Schiff founded internal cardiac massage in 1874 but never saw the benefit of external chest compression. The benefit of external chest compressions was discovered by Kouwenhoven (pictured below), Knickerbocker and Jude in 1958, during his research in to external defibrillation on dogs. The paddles at the time were very heavy and Kouwenhoven noticed that when the paddles where applied forcefully, blood pressure increase proving the basis for understanding the benefit of chest compression (2005, Hunt).

In early research by Harkins and Bramson in 1961 found that external chest compressions could be performed effectively using a machine (The Cardic Massage Unit, pictures below) (Harkins and Bramson, 1961). Due to their early understanding of the recognition of life

extinct, at least an hour of CPR was given before effort to resuscitate was terminated. This was a very strenuous undertaking and required a team of people, rotating regularly, to provide effective compressions. Their invention was later fundamental to the research that took place to find the optimal rate and pressure of compression, as it provided a way to accurately standardise testing and provide more accurate results compared to manual compressions. The Cardiac Massage Unit was powered by compressed oxygen. The compressed oxygen filled the ram, exerting pressure on the chest and compressing the heart. As the oxygen is released, pressure is taken off the chest and natural recoil allows for re-expansion of the thoracic cavity and refill of the heart.

In 1963 Bailey, Browes and Keating invented their own, much more compact and portable machine (pictured below). Their research showed that the most effective rate of compression was 60 per minute, at a pressure of 90lb, with a 2 second pause every 5 th

compression to allow for ventilation (Bailey et al, 1963). These recommendations stood for many years until the further development saw the adoption of the 30:2 compression/ventilation ratio with compressions at 100-120 per minute in the 2005 Resus Guidelines (Handley, 2005).

Peter Safar also created his own Beck-Rand External Cardiac Compression Machine (pictured below), as he described in The Journal of the American Society of Anesthesiologists in 1963 in collaboration with L C Harris. (Safar and Harris, 1963)

In 1965 Michigan Institutions ‘Thumper’ was produced, it has been updated may times since but is still in production (pictured below).

Several attempts made to produce mechanical aids to compression was made, where the user would push a leaver to reduce the effort needed to resuscitate in a more cost effective way (an example is pictured below) (Michael, Taylor, and Warltier, 1962).

However, in 1966 the benefits of mechanising chest compressions at this point were more for the resuscitating personnel, since little was known as to the benefit to the patient and with the high cost of the devices and the time it took to put it in place on the patient, resulting in time where no compressions were being performed, they were not recommended over manual chest compressions (Harrison-Paul, 2007).

In the late 1970’s and early 1980’s enthusiasm waned for the mechanical devices, although the Thumper was one machine that did continue to be used throughout this period. In the mid 1980’s Vest-CPR was invented, whereby the chest was squeezed by an inflating vest rather than compressed by a piston (Halperin, H. and FAHA, 2009). At the time, initial reviews showed great promise for improving survival rates, this resulted in ZOLL developing the Auto-Pulse that is on sale today. More recent evidence shows mixed results and again it was suggested that more evidence was needed before the device was adopted and its use limited to situations where manual CPR is impractical or unsafe (Pearson, Navarro, and Redding, 1966).

In 1991 Willy Vistung developed the Lucas device with the aid of Professor Stig Steen and under the ownership of Jolife AB and a distribution agreement with Physio-Control. Initially this device offered both chest decompression as well as chest compression by the piston pulling back up on a suction cup that is attached to the patient. Following verying reports again on the effectiveness of this alteration is was suggested in 1992 that it not be recommended for use until further evidence is gathered (Halperin, 1992). The Lucas device was brought to the European market in 2002 and in 2009 the Lucas device was the first battery operated machine and became very popular within the USA and Europe (LUCAS™, no date).

The popularity of the Lucas and other such products during 2000’s brought about the increased opportunity to gather information and research as to whether there was a clinical benefit to the patient by using a mechanical chest compression device over manual compressions. The most substantial trials were PARAMEDIC, ASPIRE CIRC and LINC, trials that are discussed further later in this poster. However, any clinical benefit to using these machines is not yet totally understood due to mixed findings and ethical boundaries that research must be conducted within. Currently the Resus Guidelines (2015) do not recognise mechanical chest compression devices as a replacement for good quality manual compressions, but do recognise they are a reasonable alternative where manual chest compressions are impractical or unsafe (Soar et al., 2015).

References

Acierno, L.J. and Worrell, L.T. (2007) ‘Peter Safar: Father of modern cardiopulmonary resuscitation’, Clinical Cardiology, 30(1), pp. 52–54. doi: 10.1002/clc.20042.

Bailey, R.A., Browse, N.L. and Keating, V.J. (1964) ‘AUTOMATIC EXTERNAL CARDIAC MASSAGE: A PORTABLE PNEUMATIC EXTERNAL CARDIAC COMPRESSION MACHINE’, 26(4).

Halperin, H. and FAHA (2009) Through the years. Available at: http://www.jems.com/articles/2009/08/through-years.html (Accessed: 9 January 2017).

Halperin, H.R. (1992) ‘New approaches to CPR. Four hands, a plunger, or a vest’, JAMA: The Journal of the American Medical Association, 267(21), pp. 2940–2941. doi: 10.1001/jama.267.21.2940.

Handley, A. (2005) Adult life support. Available at: https://www.resus.org.uk/archive/guidelines-2005/ (Accessed: 11 January 2017).

Harkins, G.A. and Bramson, M.L. (1961) ‘Mechanized external cardiac massage for cardiac arrest and for support of the failing heart: A preliminary communication’, Journal of Surgical Research, 1(3), pp. 197–200. doi: 10.1016/S0022-4804(61)80043-7.

Harrison-Paul, R. (2007) ‘A history of mechanical devices for providing external chest compressions’, Resuscitation, 73(3), pp. 330–336. doi: 10.1016/j.resuscitation.2007.01.002.

Hurt, R. (2005) ‘Modern cardiopulmonary resuscitation—not so new after all’, 98(7).

LUCAS™ (no date) Milestones in the history of LUCAS™. Available at: http://www.lucas-cpr.com/en/about_us/history (Accessed: 11 January 2017).

Michael, T.A.D., Taylor, D.J.E. and Warltier, A.W. (1962) ‘The management of cardiac arrest in a general hospital’, Postgraduate Medical Journal, 38(444), pp. 560–570. doi: 10.1136/pgmj.38.444.560.

PEARSON, J.W., NAVARRO, R.N. and REDDING, J.S. (1966) ‘Evaluation of mechanical devices for closed-chest cardiac massage’, Anesthesia & Analgesia, 45(5), pp. 590–598. doi: 10.1213/00000539-196645050-00015.

SAFAR, P. and HARRIS, L.C. (1963) ‘GADGETS the Beck-Rand external cardiac compression machine’, The Journal of the American Society of Anesthesiologists, 24(4), pp. 586–587.

Soar, J., Deakin, C., Lockey, A., Nolan, J. and Perkins, G. (2015) Adult life support. Available at: https://www.resus.org.uk/statements/rc-uk-resuscitation-guidelines-2015-published/ (Accessed: 11 January 2017).