By Tammie Smith, Times-Dispatch staff writer
Richmond Times Dispatch (Virginia)
Copyright 2006 Richmond Newspapers, Inc.
A device that is strapped around the chest and does cardiopulmonary resuscitation chest compressions automatically is saving lives in Richmond, but researchers elsewhere studying the device show opposite results.
Studies in today’s issue of the Journal of the American Medical Association differ on whether patients who go into cardiac arrest outside the hospital do better when they get manual chest compressions by trained emergency medical workers versus chest compressions done by AutoPulse, an automatic device strapped over the patient’s chest.
One of the journal studies is based on the experience of the Richmond Ambulance Authority, which has been using AutoPulse since late 2003. The study, from Virginia Commonwealth University researchers, shows the device improves the chance a patient will survive to go home from the hospital.
The lead authors on the other study are from the University of Washington. Their conclusions, which show AutoPulse patients doing worse, are based on studies of patients in Calgary, Alberta, Canada; Columbus, Ohio; Vancouver, British Columbia, Canada; and suburbs of Pittsburgh and Seattle.
The University of Washington researchers stopped their study early after results began coming in indicating that patients treated with the AutoPulse device had worse outcomes than those getting manual chest compressions by trained rescue workers.
The researchers and other experts analyzing the studies can’t explain the differing results and say more research needs to be done. Factors such as patient selection, EMS training and how quickly the device is used in the field could affect outcomes.
“One of the puzzles is why these other folks — good EMS systems — why they did not have the same experience we did,” said Dr. Joseph Ornato, professor and chairman of VCU’s Department of Emergency Medicine and medical director of the Richmond Ambulance Authority.
“I have some ideas what some of the other issues might be. I think the training we did was very clearly quite hands on, quite intense.”
“One of the other hints — we were able to see even in our own data, all of the benefits occurred when we were able to get to the scene in under eight minutes with the device, “said Ornato.
Lead author on the VCU study was Dr. Marcus Eng Hock Ong, an emergency physician from Singapore who spent a year at VCU on a postdoctoral fellowship. Ornato has served as an unpaid volunteer scientific adviser to the company that makes the devices.
Locally, various emergency medical rescue teams in Chesterfield, Henrico and Goochland counties use AutoPulse. Chesterfield recently got a matching grant to get 12 AutoPulse devices, which cost about $12,000 each.
“Bobby Lukhard, EMS director for Chesterfield County Fire and EMS, said, “We evaluated these devices about a year ago.... They do deliver more efficient and effective CPR than a human can, just because of consistency.”
He said the devices also allow consistent chest compressions, for instance, when a patient is being moved down stairways, and are safer for EMS workers.
Standing up in back of an ambulance, doing compressions with one hand and holding on with the other as the ambulances turn corners and stop can be hazardous for EMS workers, Lukhard said.