Vol.1, No.2, 5-7 (2013) Open Journal of Emergency Medicine
Current situation of mechanical CPR devices in
donors after cardiac death
Alonso A. Mateos Rodríguez1*, José María Navalpotro Pascual1,
Vicnete Sanchez Brunete Ingelmo1, Francesc Carmona Jiménez2
1Servicio de Urgencias Médicas de Madrid SUMMA112 (Emergency Medical Services of Madrid), Madrid, Spain;
*Corresponding Autho r : amateos.summa@salud.madrid.org
2Servei Emergencies Mediques (Emergency Medical Services), Barcelona, Spain
Received 17 October 2013; revised 19 November 2013; accepted 5 December 2013
Copyright © 2013 Alonso A. Mateos Rodríguez et al. This is an open access article distributed under the Creative Commons Attribu-
tion License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited. In accordance of the Creative Commons Attribution License all Copyrights © 2013 are reserved for SCIRP and the owner of
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Mechanical CPR (cardi o pu lm on ary r es us ci tation)
devices help performing correct chest compres-
sions in the event of a cardiorespiratory arrest.
These devices are comfortable and useful, they
keep chest compression following the recom-
mendations as they do not depend on interper-
sonal variability, they do not get tired, their use
is simple and one of the rescuers is released
from this task, thus facilitating the assistance.
Besides, the ir use in tran sport c onditi ons ma kes
it safer. However, when coming to results, these
mechanical CPR devices have not clearly dem-
onstrated such an advantage, neither in the field
of cardiac arrest, nor in organ preservation in
the case of d onors after cardiac death . In donors
after cardiac death they are widely used by most
of the emergency services involved, but a num-
ber of injuries produced in lungs during the ear-
ly years of their use have made it controversial.
In this paper w e make a review of the road trav-
eled by mechanical CPR dev ices a nd of the main
articles which mark the way.
Keywords: Emergency Medical Services; Donors
after Cardiac Death; Cardi oc o mpressors
In the last few years, several mechanical devices have
been developed to replace manual cardiac massage in the
event of a cardiorespiratory arrest. These devices have
shown to improve quality of cardiopulmonary resuscita-
tion [1] and, in some cases, an improvement of short-
term survival has been proven [2,3]. Two devices are
currently being used: LUCAS©, Lung University Cardiac
Arrest System, from the company Physio-Control, and
Autopulse©, from Zoll. There is a third device in the
market from the company Corpuls based on a piston-arm
with a base recalling the o ld devices, but improved.
LUCAS© is a piston system with a suction cup which
attaches the patient chest in a specific point. By means of
oxygen or compressed air in version 1 and rechargeable
batteries in version 2, it exerts pressure up and down.
Autopulse© exerts the same pressure on the chest, but
does so by means of a load distribution band which em-
braces the patient trunk, and uses rechargeable batteries.
Both devices have two possibilities for performing chest
compressions: rhythm 30:2 or continuous massage, and
they present as an additional advantage the fact that one
of the rescuers involved in resuscitation is released from
this task. Their use and placement are very simple. They
are widely used by most of the emergency services in
cardiopulmonary arrest cases and in organ donation in
asystole [4]. Due to its cost it is complicated for these
devices to be shipped with the whole fleet of mobile re-
sources, therefore, most emergency services carry them
on a special vehicle featured in the scene at the request of
the professionals. Their primary use is intended for the
return of spontaneous circulation, and if this is not achi-
eved, devices are used for the transfer of the potential
donor if this is the case.
In Spain, the Organización Nacional de Trasplantes
(National Transplant Organization), in its consensus
document for promoting donors after cardiac death, rec-
ommends the use of these devices as a way of imple-
menting programs of donation in asystole. At European
level, a document is being drafted in the same direction
of the Spanish one recommending their use as well [5].
Copyright © 2013 SciRes. OPEN ACC ESS
A. A. M. Rodríguez et al. / Open Journ al of Emergency Medicine 1 (2013) 5-7
Many studies have been published referring to the pos-
sible injuries that mechanical CPR devices could cause
to patients. Smekal et al. already proved that injuries pro-
duced by these devices were similar to those found on
cases of manual chest compression [6]. However, in spite
of studies like this, the repu tation of the mechanical CPR
devices was determined on the side of injuries. In this
review we want to debunk this myth on the basis of sev-
eral articles published in the last few years.
Mechanical CPR devices have not yet demonstrated a
clear return of spontaneous circulation. There are two
studies which are working on th is objective in a random-
ized way. CIRC Trial studies the Autopulse©, and in pre-
liminary data it has proven to have the same rate of sur-
vival to hospital disch arg e than high-qu ality manual mas-
sage. The problem is, who can achieve this high-quality
manual massage for an extended time [7]. So does LINC
Trial with LUCAS©, the LINC study showed similar
short-term survival rates for LUCAS (23.6%) and man-
ual (23.7%) chest compressions. At 6-months, 8.5% of
the patients treated with LUCAS were alive with good
neurological outcomes compared to 7.6% in the manual
group [8].
Despite not having shown a clear improvement in
ROSC [9] (return of spontaneous circulation) or in sur-
vival to hospital discharge, they make it when it comes to
optimum fulfillment of protocols [10,11] and safety in
cardiopulmonary resuscitation [12,13]. Only these two
aspects, on equal terms with manual chest compression,
already justify their use.
In 2010 we published an article where we evaluated
the efficiency of CPR devices as an organ preservation
method [14]. We compared two groups of donors after
cardiac death of approximately 40 cases each; one group
was assisted with CPR devices and the other one with
manual chest compression. The rate of kidneys and the
rate of organs and tissues per donor were significantly
lower in the group of donors assisted with mechanical
CPR devices. These data made us wonder if the use of
these devices was correct, and we started to study them
The limits of our study were clear, since we collected
just a few cases and we only evaluated transplanted or-
gans without considering their evolution thereafter. In
detail, and if we just evaluate kidney grafts, data offered
by a group of donors assisted with CPR devices vs man-
ual cardiac massage are almost the same. The cases of
primary graft failure were similar in both groups and
present a very low frequency, around 8% [15]. Later, it
has been observed that long-term function of kidney
grafts is very similar in both groups of patients. Data
from a cohort of 50 other donors divided into CPR de-
vices and non-CPR devices reveal that, after 6 and 12
months, the renal function (creatinine) was somewhat
higher in the group assisted with CPR devices, but not
reaching pathological levels and without being statisti-
cally significant [16]. In a similar study, in which LU-
CAS© was evaluated, results marked a clear advantage in
favour of CPR devices [17], objectifying an improve-
ment of 0.3 kidneys transplanted per donor in the CPR
devices group and a decrease of 32.9% of kidney grafts
discarded because of poor perfusion. It seems proved that
CPR devices do not affect further evolution of kidney
grafts, actually, they may even improve it.
As a matter of fact, injuries produced by CPR devices
usually appeared in lungs, as it can be easily understood
because of the pressure exerted over them during car-
diopulmonary resuscitation. These injuries have been
commented many times, but never published. Numerous
articles have appeared objectifying the presence of trau-
matic injuries on the chest and lungs of patients assisted
with mechanical CPR devices, and in all of them results
are similar: there is no significant difference between
injuries produced by manual chest compression and
those caused by mechanical devices [6,18-20]. Even in a
number of lungs evaluated for transplantation from pa-
tients which had been assisted with CPR devices, major
injuries were not noticed, or at least, not that major inju-
ries as to discard the lungs for transplantation. In patients
considered as donors 8 pathological bronchoscopes were
objectified, 3 of them with bronchial aspiration and 5
with blood-borne secretions; no rib fractures were no-
ticed but there appeared 2 cases of sternal fracture. Inju-
ries were never described as serious, and they were never
a potential reason for discarding the organ for transplan-
tation. This kind of lung grafts presents a highly satisfac-
tory evolution thereafter. Out of 20 patients receiving
lungs from donors after cardiac death, 18 survived the
first month [21]. Most of these lungs had been subjected
to CPR devices.
Even though it seems that at first mechanical CPR de-
vices had been associated with the presence of injuries in
organs of patients assisted with them, and that their use
Copyright © 2013 SciRes. OPEN ACC ESS
A. A. M. Rodríguez et al. / Open Journ al of Emergency Medicine 1 (2013) 5-7
Copyright © 2013 SciRes. OPEN AC CESS
in donor processes seemed to decrease the number of
suitable organs, these data have not been confirmed by
further investigations. While it is true that in few occa-
sions have they shown an improvement compared to
manual chest compression, the advantages that they offer
make their use generalized and unquestionable. Further
studies with a larger number of populations are n eed ed to
know in detail the results of these mechanical CPR de-
vices in organs which are candidates to be transplanted.
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