The outcome of out-of-hospital witnessed cardiac arrest undergoing CPR is disappointing with only very few of the patients actually being alive and discharged from the hospital with intact neurological status 30 days after the arrest. We hereby describe observations from charts review of 17 patients in cardiac arrest. All patients were in terminal arrest, comatose and with dilated pupils.
Methods: The patients were treated in the ED with auto-transfusion tourniquets (A-TT) placed on one or both their legs in addition to routine CPR protocol. The A-TT is an elastic ring that is tightly rolled up the limb to shift the blood from the limb to the core and prevent its re-entry to the limb. The data is based on retrospective chart review of the ED records of patients who were treated with A-TT per ED physician’s clinical judgement. The ED charts were critically reviewed for history of arrest event, condition upon ED arrival, technical aspects of A-TT placement, cardiac rhythm prior to and after A-TT placement and patient disposition.
Results: All patients were brought to the ED while receiving standard CPR by paramedics 22 to 56 minutes after they collapsed. In seven of the patients the collapse was unwitnessed (2) or was due to non-cardiac etiology (GI bleed (1), traumatic pneumo /hemothorax (1), drug overdose (2) or an inadequate A-TT was use (1 patient)). The collapse event in the other 10 patients was witnessed and of presumed cardiac cause. Seven of the 10 patient (70%) showed ROSC within 1-5 minutes from the A-TT placement on one or both legs. 5 (50%) of the patient had sustained spontaneous circulation long enough to be transferred to the ICU for brain preservation treatment and one of those (Pt #5) recovered and was discharged 30 days after the arrest in good neurological status.
Conclusion: These cases indicate that mechanical distal-to-proximal squeezing of the blood by the A-TT can improve the chances of ROSC in witnessed cardiac arrest when applied together with standard CPR. Clearly, additional large scale, pre-hospital controlled studies should be done in order to verify and optimize the use of A-TT in cardiac arrest patients.
