![]() The observation that mechanical CC solve some of the issues with manual CC without improving outcomes raises several unanswered questions about how we use the devices today. Only studies comparing with historical controls have shown a benefit. Methodology in such studies makes those findings suspect due to resuscitation time bias because the devices tend to be applied later in resuscitation attempts, the cohort of patients treated by them are already less likely to survive when the device is applied. Mechanical CC devices should be able to solve this problem but, if so, why have most studies failed to show improvement in outcomes? Multiple observational studies have come up with negative results (mechanical CC was worse). A provider will tire quickly, and this will reduce CPR quality and potentially impact outcome. ![]() Most people will agree that manual CC are tiring and difficult to perform, especially during transport. Is there a need for them? What CPR issues will be solved? Do they perform better than high quality manual CPR? Are there unintended consequences? Will their use shift the focus from patient care to device care? These questions and answers highlight the controversies about the effectiveness of these devices. Important questions should be asked about these devices. One way, motivated by the observation that manual chest compressions (CC) are difficult to perform, has been to introduce manual or powered mechanical chest compression devices that seem to have potential to increase blood flow and improve outcome. Over the last 60 years, we have tried many ways to improve cardiopulmonary resuscitation (CPR) techniques for cardiac arrest patients. These device-oriented approaches enable you to fit chest compression devices into an overall approach to high performance CPR in ways that are both consistent with the evidence and compatible with the realities of resuscitation. If continuous chest compressions, the person ventilating must only concentrate on that and give a quick breath between every nine to ten compressions. Use 30:2 mode to facilitate ventilation, whether ventilating with bag/valve/mask, supraglottic device, or endotracheal tube.Promptly reposition the device if it is visually out of correct position, if ETCO 2 is low, or if the palpated chest compression pulse is weak. ![]()
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