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Resusc Plus
Resusc Plus
Resuscitation Plus
2666-5204
Elsevier

S2666-5204(24)00210-8
10.1016/j.resplu.2024.100759
100759
Letter to the Editor
Do different mechanical compressors provide equivalent hemodynamic support during cardiopulmonary resuscitation?
Silvestri Ivan 1
Department of Pathophysiology and Transplantation, University of Milan, Italy
Department of Anaesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Stirparo Giuseppe 2
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Bonetti Claudia
Department of Pathophysiology and Transplantation, University of Milan, Italy
Department of Anaesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Maria Beatrice Guerra
Department of Pathophysiology and Transplantation, University of Milan, Italy
Department of Anaesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Ruberti Serena
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
ASST Papa Giovanni XXIII, Bergamo, Italy
Coppo Anna
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Migliari Maurizio
Agenzia Regionale Emergenza Urgenza (AREU), Milan, Italy
Ristagno Giuseppe gristag@gmail.com
⁎
Department of Pathophysiology and Transplantation, University of Milan, Italy
Department of Anaesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
⁎ Corresponding author at: Department of Pathophysiology and Transplantation, University of Milan, Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy. gristag@gmail.com
1 Author I.S. played equal roles.

2 Authors G.S. played equal roles.

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© 2024 The Author(s)
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcHigh-quality chest compression is crucial during cardiopulmonary resuscitation (CPR) to maintain adequate tissue perfusion, ultimately leading to return of spontaneous circulation (ROSC) and favorable neurological outcomes.1, 2, 3 Mechanical compression devices offer a viable alternative to manual resuscitation, especially in prolonged CPR and/or during transport.4, 5 However, the diverse designs and compression techniques of available devices can impact CPR outcomes.4, 5, 6 A recent retrospective analysis of 2146 out-of-hospital cardiac arrests (OHCA) treated with three different mechanical compressors, i.e. LUCAS® (Stryker), Autopulse® (ZOLL Medical), and EasyPulse® (Schiller), revealed significant differences in ROSC and survival.6 Nevertheless, comparative studies on the devices’ performance in terms of hemodynamic support generated, are lacking.

The aim of this study was to compare the hemodynamic efficacy of two mechanical compressors, LUCAS® and EasyPulse®, by assessing end-tidal CO2 (EtCO2) as a surrogate marker3, 7, 8 in the OHCAs occurring in Lombardy, Italy, during 2021. More specifically, all available defibrillator records (stored in the Regional database) from patients who underwent mechanical CPR and advanced airway management with continuous EtCO2 monitoring, were included. The first 20 min of CPR were analyzed. The study was approved by the “Milano Area 2” Ethical Committee (no. 653_2022bis), and informed consent was waived due to the retrospective observational design. Categorical variables were compared by χ2 test, while continuous ones were analyzed with a 2-way ANOVA. A p < 0.05 was considered as statistically significant.

Data from 143 OHCAs were analyzed, with 84 cases using LUCAS® and 59 using EasyPulse® (Fig. 1). No significant differences were found in population and CPR characteristics (including ventilation rate), except for a higher incidence of shockable cardiac arrests in the EasyPulse® group compared to the LUCAS® one (p < 0.05). Patients compressed with LUCAS® exhibited consistently higher EtCO2 levels compared to those compressed with EasyPulse® (p < 0.001, Fig. 1). This difference was present in both shockable and non-shockable arrests (Fig. 1). A trend towards higher sustained ROSC rate was observed in the LUCAS® group compared to the EasyPulse® one.Fig. 1 Population characteristics and end-tidal CO2 (ETCO2) during out-of-hospital cardiac arrest (OHCA) in the whole population and in shockable and not-shockable cardiac arrests (CA). CA, cardiac arrest; CPR, cardiopulmonary resuscitation; EMS, Emergency Medical system; ROSC, return of spontaneous circulation. Data in table are reported as n (%) or median [IQR]. Data in graphs are reported as mean over time (minutes of CPR). * p < 0.05 vs. LUCAS®.

Acknowledging the limitations inherent in a retrospective study with a small sample of defibrillator records available, our findings suggest that LUCAS® may be more effective than EasyPulse® in generating hemodynamic support and perfusion during CPR. These results highlight the potential impact of different mechanical compression techniques, such as piston (LUCAS®) vs. a combination of piston and band type (EasyPulse®), on cardiac output, as evidenced by the large difference in EtCO2.5 This discrepancy in hemodynamic performance, likely related to a different way of exploiting the cardiac and/or the thoracic pump theory behind CPR physiology, may ultimately lead to the divergent ROSC and survival rates earlier reported.6

To fully understand the pathophysiology underlying the varying performance of different compression devices, further larger prospective clinical trials are needed. These studies should focus on direct measures of perfusion, including blood pressure, EtCO2, and cardiac output, or other perfusion assessments. Addressing this knowledge gap is crucial for optimizing resuscitation outcomes, as the increasing availability of diverse mechanical compressors needs a clear understanding of their relative effectiveness in generating blood flow during CPR.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: No relationship exists between any of the authors and any commercial entity or product mentioned in this manuscript that might represent a conflict of interest. No inducements have been made by any commercial entity to submit the manuscript for publication. GR is the European Resuscitation Council Director Congresses and Board member of Resuscitation Plus. All the other authors declared no COI.
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References

1 Magliocca A. Castagna V. Fornari C. Transthoracic impedance variability to assess quality of chest compression in out-of-hospital cardiac arrest Acta Anaesthesiol Scand 68 2024 556 566 38221650
2 Nordseth T. Eftestøl T. Aramendi E. Extracting physiologic and clinical data from defibrillators for research purposes to improve treatment for patients in cardiac arrest Resusc Plus 18 2024 100611
3 Kool M. Atkins D.L. Van de Voorde P. Focused echocardiography, end-tidal carbon dioxide, arterial blood pressure or near-infrared spectroscopy monitoring during paediatric cardiopulmonary resuscitation: A scoping review Resusc Plus 6 2021 100109
4 Magliocca A. Olivari D. De Giorgio D. LUCAS versus manual chest compression during ambulance transport: A hemodynamic study in a porcine model of cardiac arrest J Am Heart Assoc 8 2019 e011189
5 Lederer W. Schwaiger D. Baubin M.A. Improving survival from mechanical chest compression resuscitation Resusc Plus 11 2022 100285
6 Primi R. Bendotti S. Currao A. Use of mechanical chest compression for resuscitation in out-of-hospital cardiac arrest-device matters: a propensity-score-based match analysis J Clin Med 12 2023 4429 37445464
7 Ryu S.J. Lee S.J. Park C.H. Arterial pressure, end-tidal carbon dioxide, and central venous oxygen saturation in reflecting compression depth Acta Anaesthesiol Scand 60 2016 1012 1023 27080141
8 Bray J. Rea T. Parnia S. Wolf creek XVII part 6: Physiology-guided CPR Resusc Plus 18 2024 100589
