Elsevier

Air Medical Journal

Volume 33, Issue 6, November–December 2014, Pages 299-301
Air Medical Journal

Brief Report
Benefit of Mechanical Chest Compression Devices in Mountain HEMS: Lessons Learned From 1 Year of Experience and Evaluation

https://doi.org/10.1016/j.amj.2014.05.002Get rights and content

Abstract

Introduction

Pre-hospital care of cardiac arrest patients in the mountain environment is one of the most challenging problems for helicopter medical emergency services (HEMS) teams. To provide high-quality chest compression with minimal hand s-off-time is very demanding in the alpine area.

Methods

We used and evaluated mechanical chest compression devices (Lucas and AutoPulse) and investigated if these are good and useful tools in the alpine HEMS. Over a period of 12 months we performed 7 CPRs in remote alpine terrain.

Conclusion

On the strength of our past experience, CPR under special circumstances like deep hypothermia, in which a prolonged CPR is essential, the use of the Lucas and/or AutoPulse was an easy and sufficient tool even in difficult alpine terrain which requires special rescue missions like winch or MERS evacuation.

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

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