showed that a larger number of subjects who received CPR with the
ResQCPR System survived cardiac arrest long-term.
The ResQCPR System consists of two devices that are used together
by trained rescuers while they’re performing CPR: 1) the ResQPUMP
active compression-decompression CPR (ACD-CPR) device; and 2)
the ResQPOD impedance threshold device (ITD). The devices have
been shown to significantly improve the patient’s chances of surviving an out-of-hospital, non-traumatic cardiac arrest. 2, 3
I had been interested in the device combination since seeing demonstrations on its physiology in the
laboratory. The device utilizes
and enhances natural physiology, providing for better cardiac output and better cerebral
Traditional CPR has a “push
and relax” duty cycle, but the
device with a suction cup that’s
placed on the patient’s chest—
actually allows the rescuer to
pull up and actively re-expand
the chest wall (i.e., “push and
pull”). This ACD-CPR creates a vacuum in the intrathoracic cavity
that increases blood flow to the heart and brain.
This vacuum is maintained and enhanced when used with the
ResQPOD ITD in the airway circuit. As more blood is drawn back
to the heart during the decompression phase, this enhanced preload
results in a greater volume of blood flowing out of the heart (i.e., cardiac output) during the next compression.
The synergy of the two devices has been shown in studies to provide
near normal blood flow during CPR. 4–6 By facilitating high-perfusion
CPR, it’s more likely patients who survive will be neurologically intact.
TRAINING & IMPLEMENTATION
In spring 2015, CFR purchased six ResQCPR Systems. In conversations with department leadership, I conveyed that the science is supportive of the technology and that I was confident that the quality
of CPR would be better than manual—or even mechanical—CPR.
Formal staff training was conducted over a period of one week.
The ACD-CPR device is different from standard CPR, but it’s fairly
intuitive, and the ResQCPR System provides real-time, electronic
guidance to the rescuer to help them accommodate for the differences.
A force gauge provides information on compression and lifting forces, while the metronome
guides the rescuer to compress
at the appropriate rate. Timing
lights on the I TD can be turned
on to cue rescuers on the proper
ventilation rate minimizing the
likelihood of hyperventilation.
These features help promote
high-quality CPR at all times.
After the initial training, the
cardiac arrest protocol was revisited to determine if it needed
adjustment. Changing the protocol was simple and straightforward.
It was updated to make it clear that any time a patient was in cardiac
arrest, the ResQPOD ITD was to be used along with manual CPR
to improve perfusion. As soon as the ResQCPR System arrives on
scene, the ResQPUMP is utilized with the ResQPOD.
RESULTS & SAFETY BENEFITS
Within 4–6 weeks from the time the devices were purchased, CFR
staff were fully trained and the equipment was being used regularly.
Immediately after the teams started using the ResQCPR System,
they experienced improved outcomes. Right off the bat, in the first
eight cardiac arrests, CFR had seven neurologically intact saves, which
was remarkably better than what they’d had before.
The one patient they weren’t able to resuscitate had suffered a cardiac arrest while riding his bike, causing him to fall and sustain a serious head injury. Although CFR crews were successful in restoring his
heartbeat, he eventually succumbed to his head injury.
The early successes created confidence among the CFR EMS staff
that the technology worked, and their enthusiasm has remained high.
The CFR EMS chief was initially pretty skeptical about the
ResQCPR System, but then he started getting calls from family
members thanking them for saving their loved ones’ lives. He told me,
“I never got those before.”
CFR has also noticed something unique when using the ResQCPR
System. In the past, they never had cases of patients in cardiac arrest
responding to them during the resuscitation. However, when using
these two devices, they experienced some patients literally reaching
their arms out to the crews or trying to pull out their endotracheal
tubes despite being in cardiac arrest.
They’ve never had to deal with this before. It tells me that the brain
is being perfused well enough for patients to respond, despite being
in cardiac arrest. That’s an encouraging sign.
As a result of patients experiencing these episodes of increased
Real-time electronic guidance helps ensure accurate compression depth, lift
height and compression rate.
In the first eight cardiac
arrests, CFR had seven
neurologically intact saves,
which was remarkably better
than what they’d had before.