Brief ReportBenefit of Mechanical Chest Compression Devices in Mountain HEMS: Lessons Learned From 1 Year of Experience and Evaluation
Introduction
Mountain rescue operations often present helicopter medical emergency service (HEMS) crews with unique challenges. One of the most challenging problems is the prehospital care of cardiac arrest patients in the mountain environment during evacuation and transport.1 These scenarios are demanding medical situations in which continuous cardiopulmonary resuscitation (CPR) in mountain terrain requires the HEMS crew to make quick decisions and provide solutions to complex cases. High-quality chest compression with minimal hands-off time has been proven to be of critical importance for both the patients' survival rate and the neurologic outcome after cardiac arrest. Even in relatively normal conditions of urban rescue, it can be difficult to control these requirements, as several studies have shown. For example, in difficult mountain terrain, if a patient has to be rescued out of an avalanche in high altitude in a steep incline and then has to be transported or even winched up to the helicopter, the task of providing sufficient CPR becomes extremely difficult. Studies have already shown that interruptions of CPR caused by helicopter transport result in a significantly reduced survival rates of these patients.2 So far, there are limited data in simulated scenarios suggesting that mechanical devices can be put to use to achieve good results in HEMS, but there has been no practical experience in a mountain setting up to now.3 We decided to evaluate if mechanical chest compression devices (Lucas [Physio-Control, Inc., Lund, Sweden] and AutoPulse [Physio-Control, Inc.]) are beneficial tools in alpine HEMS.
Section snippets
Clinical Case Observation
We looked into the number of CPRs performed with mechanical chest compression devices and the practical experience gained in 1 year by the HEMS of 2 alpine bases of Air Zermatt in Switzerland.
Over this period of 12 months, we performed 7 CPRs with a mechanical chest compression device (AutoPulse = 4 and Lucas = 3). Six of these events occurred in remote alpine terrain. The evacuation of the majority of these victims was performed by loading the patient while hovering (n = 5) (Fig. 1); in 1
Discussion
In theory, the strategy of using a chest compression tool might improve the poor outcome in out-of-hospital cardiac arrest situations, but in a recently published study focusing on an urban emergency medical service,4 there was no significant difference in the 4-hour survival rate between patients treated with a mechanical CPR algorithm and those treated with guideline-adherent manual CPR.
However, the opportunity to provide guideline-adherent manual CPR is usually very limited when it comes to
References (6)
- et al.
Mechanical chest compressions in an avalanche victim with cardiac arrest: an option for extreme mountain rescue operations
Wilderness Environ Med
(2014) - et al.
The ability to perform closed chest compressions in helicopters
Am J Emerg Med
(1994) - et al.
LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue—a prospective, randomized, cross-over manikin study
Am J Emerg Med
(2013)
Cited by (12)
Mechanical Cardiopulmonary Resuscitation's Role in Helicopter Air Ambulances: A Narrative Review
2022, Air Medical JournalCitation Excerpt :Research examining mCPR use in the HEMS setting has involved single-patient case reports, multiple-patient studies, and simulation/scenario-based studies. Pietsch et al34 reported a case of a skier who was trapped in an avalanche and found in cardiac arrest by other skiers who began manual CPR. HEMS arrived roughly 1 hour after the avalanche and initiated mCPR for transport by helicopter.
Cardiopulmonary Resuscitation Quality by Helicopter Rescue Swimmers While Flying
2016, Air Medical JournalCitation Excerpt :It can be argued that the specific characteristics of environment, resuscitation, and transport reproduced in our study could be ideal to test the performance of MCCDs in this setting and to compare them with manual CPR. Potential advantages of MCCDs could be the continuity of CCs; avoiding hands-off time; and the maintenance of CC depth, rate, and decompression values along the time.23,24 Future simulation studies should test that hypothesis.
European Resuscitation Council Guidelines for Resuscitation 2015. Section 1. Executive summary
2015, ResuscitationCitation Excerpt :If a shockable rhythm (VF/pVT) is recognised in a monitored patient and defibrillation can be accomplished rapidly, immediately give up to three-stacked shocks before starting chest compressions. Mechanical chest compression devices enable delivery of high quality chest compressions in the confined space of an air ambulance and their use should be considered.332,333 If a cardiac arrest during flight is thought to be a possibility, consider fitting the patient within a mechanical chest compression device during packaging before flight.334,335
European Resuscitation Council Guidelines for Resuscitation 2015. Section 4. Cardiac arrest in special circumstances
2015, ResuscitationCitation Excerpt :In smaller helicopters, there may be insufficient room to perform effective resuscitation and an emergency landing may be necessary to allow better patient access. Mechanical chest compression devices enable delivery of high quality chest compressions in the confined space of an air ambulance and their use should be considered.248,524 If a cardiac arrest during flight is thought to be a possibility, consider fitting the patient within a mechanical chest compression device during packaging before flight.50,525
Mountain Rescue Service in Germany
2020, NotarztMechanical chest compression devices in the helicopter emergency medical service in Switzerland
2020, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine