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162-955 / Out-of-hospital use of AutoPulse in CPR

Croatia
GOP Information  
 
Organisation sharing the GOP
Related practices from PaSQ database
Emergency Medicine Department in Varazdin County, Croatia

Topic

Program on quality and safety
Quality improvement project
Category
Medical devices / Equipment
Implementation of Patient Safety initiatives / Activities
GOP Description
 
Implementation level
Local
Clinical settings
No.
Objectives
Objective is to evaluate the efficiency, practicability, patient and emergency medical team safety of AutoPulse while performing cardiopulmonary resuscitation.
Population
Patients with cardiopulmonary arrest of non-traumatic origin. Pregnant patients were excluded. This includes patients with ventricular tachycardia and ventricular fibrillation but primarily patients with asystole and pulseless electrical activity (PEA).
Methods
 
Methodology
Measurements of efficiency were the proportion of patients with a return of spontaneous circulation (ROSC) and survival rate. Practicability, patient and emergency medical team safety were analyzed by doctors and medical technician experience working in practice.
Timeframe implementation
Timeframe implementation is two years because there is a need for better medical staff education and relevant number of patients with cardiac arrest in which CPR procedure AutoPulse will be used.
Implementation tools available
AutoPulse is a non-invasive cardiac support pump. It is constructed around a back-bord that contains a motor to retract a load-distributing band. The patient is positioned on the board, the two broad endings of the band are placed around the patients chest and connected to each other. The length of the band automatically adjusts to the patient. AutoPulse moves more blood more consistently than it is possible with CPR.
AutoPulse ensures improved blood flow by squeezing the entire chest, not just pushing on a single spot like manual CPR.
Another advantage is ability to synchronize with respirator and defibrilator.
Implementation cost
Implementation costs include the price of the device with the necessary equipment, maintenance of equipment, and training of employees. The price of the device is unique, and the associated equipment (e.g. batteries) purchases depending on the use of the device (according to the number of interventions). Maintenance of equipment is carried out every two years. Training of employees makes no additional cost. Training is carried out by employees of the institution, and is part of the regular salary of employees. The price of the device is 110,000.00 HRK, 5000.00 HRK to maintain and additional equipment which makes a total of 115,000.00 HRK.
Results
 
Method used to measure the results
There are special forms which records a method of performing a resuscitation, which includes the use of AutoPulse device. The form contains several components: the patient's condition upon arrival of emergency team, procedures that have been performed and the outcomes. The proceedings record if the AutoPulse device has been used or not. Also outcomes measure ROSC, return of spontaneous breathing and other vital parameters. Patient and medical staff safety will be monitor by their experiences on safer resuscitation, easier resuscitation procedure and safer transport of the patient.
Results
As previously written, we still lack a sufficient number of patients to be able to present the results as relevant. That is why we mention some scientific research. All the studies show success in use of AutoPulse device:

1.    AutoPulse improved the rate of delivery of patients in ROSC sustained to the ED by 56%, according to Swanson M et al., Circulation .2006;114(18):II-554
2.    Virtually all the evidence supports the effectiveness of the AutoPulse device in increasing perfusion pressure, ROSC, and long-term survival rates. (Ong ME, Ornato J et al., JAMA. 2006;295(22):2629-2637)
Analysis of the results
The data showed that the use of AutoPulse system significantly increases the ROSC and survival rate.
It is an effective and safe mechanical CPR device useful in out-of-hospital cardiac arrest. AutoPulse minimizes no-flow time. It allows medical staff to provide compression while performing other lifesaving activities (airway management, circulation management – intravenous access, therapy etc.) or while transporting a patient (down the stairs, in the back of a moving ambulance etc.).
Medical staff impressions are that patients are safer because there is a constant compression on entire thorax which reduces the possibility of rib fractures. Also, in that way medical staff uses less energy.
Implementation barriers
 
Did you find implementation barriers?
Yes
Please describe implementation barriers
1. Economical problems (cost of AutoPulse)
2. Continous stuff eduaction
3. Change management (how to convince older medical stuff)
Describe the strategies used to overcome the barriers (If needed)
There is no specified text here
Other information
 
Other information about the GOP that you would like to add (Link or attached document)
There is no specified text here
201403120736572059_934_GOP_Ong ME, Ornato J et al..jpg
Contact information
 
Name: Adis Keranovic
Position/function: Medical doctor
Department: Emergency Medicine
Organisation: Emergency Medicine Department in Varazdin County
City: Varazdin
Country: Croatia
Region: Croatia
E-mail: adiskeranovic@gmail.com
Phone: +385915343859
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