Study Objectives
In out-of-hospital cardiac arrests (OHCA) in high-rise residences,
cardiopulmonary resuscitation (CPR) within the elevator may be necessary. The quality of conventional CPR (C-CPR) and mechanical CPR may be compromised during set-up, transport and repositioning of the stretcher to fit into the confined elevator.
Methods
We employed a triple-arm, prospective, manikin simulation study comparingthe quality of C-CPR, load-distributing band (LDB) mechanical CPR (Autopulse) and active compression-decompression (ACD) mechanical CPR (LUCAS-II) in the setting of an elevator with a standard stretcher. CPRquality was assessed using a resuscitation manikin (Resusci Anne QCPR, Laerdal). Outcomes included no flow-fraction, time to 1st shock and percentage change in compression depth between the supine and head-up stretcher positions.
Results
12 paramedic teams completed a total of 144 simulation runs with 48 runs in each arm. No-flow fraction was significantly lower in the ACD group (9.64%, CI 8.52-10.76) compared to the C-CPR group (28.64%, CI 25.92- 31.37) and LDB group (14.90%, CI 13.56-16.23). The ACD group
outperformed both other groups in percentage change in compression depth when stretcher position was changed (ACD 2.55%, CI 1.83-3.26, C-CPR 31.23%, CI 25.65-36.81%, LDB 7.07%, CI 5.88-8.26%, p<0.001). Time to 1st shock was comparable between all groups (ACD 11.66s CI 10.54-12.77s, CCPR 12.42s, CI 11.41-13.44s, LDB 11.61, CI 10.83-12.38s, p= 0.418)
Conclusion
In a simulation manikin study, ACD-CPR outperformed the other arms interms of no-flow fraction and percentage change in compression depth. Insituations where CPR is required in an elevator, usage of the ACDmechanical device can minimize deterioration of CPR quality.

1 - Simulation Study Comparing Quality of Conventional vs Active Compression-Decompression vs Load-Distribution Band CPR in a Confined Elevator: The MECHER Trial