Future Pre-Hospital Cardiopulmonary Resuscitation

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Introduction

It is important to note that cardiopulmonary resuscitation or CPR is a highly life-saving practice aimed at sustaining one’s life post-cardiac arrest, where its proper utilization can lead to significant damage minimization primarily dealt with the brain tissue. However, conducting an effective CPR is a challenging task on its own, which is why it is critical to assess whether or not there are other ways to ensure CPR delivery for an individual experiencing a heart attack, which is devoid of high levels of physical demands and appropriateness of the overall technique. Therefore, the given annotated bibliography will mainly analyze and review the recent literature on CPR in regards to novel device modification concepts, potential technological solutions, and bystander competence enhancement, and typologies of various CPR methods.

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Dziekan, M., Jubaer, S., Sell, V., Manda, S., Aboelzahab, A., Velastegui, S. R., Mejia-Viana, J. C., & Uquillas, J. A. (2017). Design of a low-cost, portable, and automated cardiopulmonary resuscitation device for emergency scenarios in Ecuador. 2017 IEEE Second Ecuador Technical Chapters Meeting (ETCM), 1-6. 

The study primarily focuses on a problem of cardiopulmonary resuscitation or CPR inaccessibility prior to the arrival of medical professionals, which is manifested in two factors, where the first is the physical and resource demand on an individual conducting such an operation, and the second one is the delay caused by the untimely provision of the medical attention. In other words, the key limiting factors for ensuring a successful reduction of preventable deaths due to out of hospital cardiac arrests are rescuer fatigue, the lack of proper CPR equipment, defective delivery of CPR by bystanders, and immediate medical care delay (Dziekan et al., 2017). The authors propose a concept model for a more affordable, portable, and easy-to-use CPR equipment, which can be used by any bystander with relative ease. The implications are rooted in the notion that a wide range of implementation and utilization of such devices can make individuals with no medical expertise competent enough to provide necessary and immediate medical care to a person undergoing a cardiac arrest outside of a hospital environment.

It is important to note that time is a critical factor during a cardiac arrest since the duration is directly correlated with the severity of brain damage received due to the lack of oxygenated blood flow. In other words, CPR is required to mimic the heart pumps of an arrested heart by applying compressions of one’s chest in order to allow the oxygenated blood to reach the brain, where blood is oxygenated through rescue breaths (Dziekan et al., 2017). The authors propose a model of a device, which is able to provide automated compressions on a person, which can also be carried due to lighter weight and can be charged from any power source, including a car.

Van de Voorde, P., Gautama, S., Momont, A., Ionescu, C. M., De Paepe, P., & Fraeyman, N. (2017). The drone ambulance [A-UAS]: Golden bullet or just a blank? Resuscitation, 116, 46–48. 

The article mainly addresses a drone-based solution called automated external defibrillator or AED drones for individuals experiencing cardiac arrest since one of the most problematic aspects of the occurrence is timing. It should be noted that even a victim survives a cardiac arrest, his or her quality of life can be deeply impacted by the arrival of proper medical care and CPR delivery. The authors argue that AED drones can become a superior alternative to the current methods of emergency medical care delivery since drones are not restrained by typical geographic constraints, such as traffic and path (Van de Voorde et al., 2017). AED drones can be operated manually by a medical professional from a distance, where he or she can both guide a person at the site and control the drone to provide the required emergency care. It is important to point out that CPR can be delivered by any bystander, where the only barrier is knowledge and experience. Deploying drones capable of being controlled by EMS dispatchers and communicating with bystanders can greatly facilitate an improvement in regards to the timely delivery of CPR.

The literature assesses the major barriers preventing a widespread integration of such drone technologies, which include costs, legal elements, policies, as well as technical issues (Van de Voorde et al., 2017). Firstly, drone ambulances can be expensive, but when calculating for healthcare costs of improperly treated patients or poor CPR delivery, drone cost effectiveness becomes more apparent and appealing as a plausible solution for prompt emergency medical services. Secondly, done technology has its major problems, and thus, legislative barriers can only be lifted with a change in societal and public opinion on drones (Van de Voorde et al., 2017). Thirdly, technical barriers revolve around the fact that such drones need to be fast and lightweight. The authors demonstrate that such drones already exist, which means that with a small set of modifications, ambulance drones are possible to incorporate into emergency medical services.

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Viereck, S., Møller, T. P., Ersbøll, A. K., Bækgaard, J. S., Claesson, A., Hollenberg, J., Folke, F., & Lippert, F. K. (2017). Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival. Resuscitation, 115, 141–147. 

The given study primarily focuses on the bystander factors and their connection to CPR delivery capabilities as well as recognition of the out of hospital cardiac arrest or OHCA cases. The authors conducted an observational analysis of a number of OHCA emergency call histories in order to assess various correlational and causal relationships between variables. The findings indicate that there is a strong positive correlation between CPR and other emergency medical care provisions by a bystander with bystander recognition of out of hospital cardiac arrest (Viereck et al., 2017). In other words, individuals who are able to recognize ab occurrence of out of hospital cardiac arrest are also more likely to be able to successfully deliver the required CPR, one-month survival, as well as spontaneous circulation return factors (Viereck et al., 2017). The results of the study show among 70% of all emergency calls, OHCA was recognized, which subsequently led to a higher degree of survival rate and bystander CPR provision (Viereck et al., 2017). In other words, the survival of individuals undergoing a cardiac arrest is directly linked to a bystander’s ability to recognize the issues, which in turn, is correlated with an increased level of competence in regards to CPR delivery.

It should be noted that the implications of the given observational study are manifested in the notion of OHCA recognition, which is a major determining factor of a prompt cardiac arrest treatment. Increasing bystander competence through an improvement of recognition within a framework of “no, no, then go” can greatly improve the overall outcome among OHCA patients. The framework is based on asking two questions whether or not an individual is conscious and whether or not an individual is breathing normally, and if the answers are no in both cases, then a high priority ambulance needs to be deployed (Viereck et al., 2017).

Zhan, L., Yang, L. J., Huang, Y., He, Q., & Liu, G. J. (2017). Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest. Cochrane Database of Systematic Reviews, 27(3), 1-48. 

The main focus of the study is to conduct a comparative analysis of the conventional CPR, which interruptive combines rescue breathing alongside chest compressions, and continuous chest compression CPR, which can be conducted either without or with rescue breathing. The researchers assessed a wide range of high quality studies to determine whether or not one method is more effective than the other. The findings are indicative of the fact that for CPRs administered by trained individuals, rescue breathing interrupted chest compressions led to a higher hospital discharge survival rate compared to continuous chest compression CPR (Zhan et al., 2017). However, when CPR is administered by a bystander or untrained individual, continuous chest compression CPRs with or without rescue breathing led to better outcomes for a victim compared to interrupted rescue breathing chest compression CPRs (Zhan et al., 2017). Therefore, utilizing continuous CPR for an untrained person might be more effective, whereas trained CPR professionals should adhere to interrupted CPR methodological framework.

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Subsequently, the implications of the study are significant since the analysis of two CPR approaches shows that a bystander needs to be self-aware on whether or not he or she can be categorized as a trained or untrained individual. If the latter is true, then one should simply focus on administering CPR on a person experiencing cardiac arrest by providing continuous chest compressions with no interruptions made for rescue breathing. However, a trained professional should provide conventional CPR since he or she is capable of providing emergency care and rescue breathing. Since the study does not base its findings on long-term outcomes, the differences require further assessments in order to identify the general survival rate after cardiac arrest.

Perkins, G. D., Lockey, A. S., de Belder, M. A., Moore, F., Weissberg, P., & Gray, H. (2016). National initiatives to improve outcomes from out-of-hospital cardiac arrest in England. Emergency Medicine Journal, 33(7), 448-451. 

The given commentary analysis primarily analyzes the role and impact of nationwide initiatives designed to improve the out of hospital cardiac arrest outcomes. It is important to note that the chain of survival among patients experiencing cardiac arrest is critical to factor in since interventional measures’ incorporation at an earlier phase can be more resultative. The earliest response is manifested in the fact that bystanders are able to recognize at-risk patients through the identification of a wide range of symptoms and signs of upcoming cardiac arrest. The second link of the chain is the provision of CPR itself, which determines both the severity of damage dealt as well as the overall survival rate. Authors suggest that the survival rate can be increased by 400% if CPR is delivered properly and timely (Perkins et al., 2016). In other words, the second phase is critical for ensuring the improved outcome of cardiac arrest. The final link includes post resuscitation care and related treatment procedures. The findings and results from observations are indicative of the fact that improving bystander CPR competence can greatly impact the overall survival rate among victims of cardiac arrests, which is why implementing national initiatives aimed at increased bystander CPR time and correct delivery method is highly relevant.

Conclusion

In conclusion, the given annotated bibliography reviewed recent literature on novel device modification concepts, potential technological solutions, and bystander competence enhancement, and typologies of various CPR methods. To provide sufficiently effective chest compressions, automatic chest compressors can be used today. With the help of automatic systems, a result is achieved that cannot be achieved manually since all compressions are effective and constant for the required time. A fixed compression depth and exact compliance with the recommendations for cardiopulmonary resuscitation are achieved. Vacuum fixation actively restores chest volume to a normal position, further improving cardiac filling and coronary artery perfusion. Experimental evidence indicates a significant improvement in blood flow to the brain and heart using the system compared to traditional CPR. Improving blood flow is key to improving survival in cardiac arrest patients. With the help of an automatic compression system, this probability can be increased. Moreover, aortic pressure is a measure of cerebral perfusion, which is critical for maintaining neurological status after patient rescue.

References

Dziekan, M., Jubaer, S., Sell, V., Manda, S., Aboelzahab, A., Velastegui, S. R., Mejia-Viana, J. C., & Uquillas, J. A. (2017). Design of a low-cost, portable, and automated cardiopulmonary resuscitation device for emergency scenarios in Ecuador. 2017 IEEE Second Ecuador Technical Chapters Meeting (ETCM), 1-6.

Perkins, G. D., Lockey, A. S., de Belder, M. A., Moore, F., Weissberg, P., & Gray, H. (2016). National initiatives to improve outcomes from out-of-hospital cardiac arrest in England. Emergency Medicine Journal, 33(7), 448-451.

Van de Voorde, P., Gautama, S., Momont, A., Ionescu, C. M., De Paepe, P., & Fraeyman, N. (2017). The drone ambulance [A-UAS]: Golden bullet or just a blank? Resuscitation, 116, 46–48.

Viereck, S., Møller, T. P., Ersbøll, A. K., Bækgaard, J. S., Claesson, A., Hollenberg, J., Folke, F., & Lippert, F. K. (2017). Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival. Resuscitation, 115, 141–147.

Zhan, L., Yang, L. J., Huang, Y., He, Q., & Liu, G. J. (2017). Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest. Cochrane Database of Systematic Reviews, 27(3), 1-48.

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NursingBird. (2022, September 7). Future Pre-Hospital Cardiopulmonary Resuscitation. Retrieved from https://nursingbird.com/future-pre-hospital-cardiopulmonary-resuscitation/

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NursingBird. (2022, September 7). Future Pre-Hospital Cardiopulmonary Resuscitation. https://nursingbird.com/future-pre-hospital-cardiopulmonary-resuscitation/

Work Cited

"Future Pre-Hospital Cardiopulmonary Resuscitation." NursingBird, 7 Sept. 2022, nursingbird.com/future-pre-hospital-cardiopulmonary-resuscitation/.

References

NursingBird. (2022) 'Future Pre-Hospital Cardiopulmonary Resuscitation'. 7 September.

References

NursingBird. 2022. "Future Pre-Hospital Cardiopulmonary Resuscitation." September 7, 2022. https://nursingbird.com/future-pre-hospital-cardiopulmonary-resuscitation/.

1. NursingBird. "Future Pre-Hospital Cardiopulmonary Resuscitation." September 7, 2022. https://nursingbird.com/future-pre-hospital-cardiopulmonary-resuscitation/.


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NursingBird. "Future Pre-Hospital Cardiopulmonary Resuscitation." September 7, 2022. https://nursingbird.com/future-pre-hospital-cardiopulmonary-resuscitation/.