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Life or death question: Is man or machine better at CPR?

Hillsborough County Fire Rescue is testing AutoPulse, which wraps around cardiac patients to provide chest compressions.

MELISSA LYTTLE | Times

Hillsborough County Fire Rescue is testing AutoPulse, which wraps around cardiac patients to provide chest compressions.

TAMPA — If you suffer cardiac arrest in the next few years and Hillsborough County Fire Rescue responds, medics may strap a band around your chest and let a machine administer CPR instead of just pounding your chest the old fashioned way.

The agency is one of five in the world participating in a new study of man vs. machine: Which one can bring you back to life faster?

Hillsborough rescuers are randomly testing AutoPulse, a new device that has had mixed reviews, on 50 percent of their cardiac arrest patients.

AutoPulse is a retractable band attached to a small blue backboard. The band slips over the patient's chest and automatically tightens, until it starts delivering deep compressions traditionally delivered by human hands.

"The central question is, 'Is one better than the other?' " said Lt. Paul Costello, study coordinator for Hillsborough Fire Rescue.

About 325,000 Americans die each year after sudden cardiac arrest.

Though approved by the U.S. Food and Drug Administration, AutoPulse has been the subject of contradictory studies.

In 2006, the Journal of the American Medical Association published the conflicting findings from two trials.

One in Richmond, Va., said AutoPulse improved patients' chances of achieving "spontaneous circulation" — meaning their heart started — on the way to the hospital. Almost 21 percent of the AutoPulse patients survived to hospital admission compared to only 11 percent of the patients who received manual CPR.

The second study, however, was halted after early data from five U.S. and Canadian study sites showed cause for concern:

Only 5.8 percent of AutoPulse patients were able to leave the hospital versus the 9.9 percent who received manual CPR only.

"They really got egg on their face the first time," said Capt. Les Williams of Collier County Fire Rescue, where emergency responders have been using AutoPulse for almost three years.

An editorial in the JAMA suggested that variations such as how long crews took to deploy the machines and at what point they used a defibrillator might have influenced the outcomes.

The new study involving Hills­borough seeks to remedy that by examining the success of the device when it is used along with a standardized response technique now known by Hillsborough first responders as the "pit crew" concept.

The NASCAR-inspired approach developed by Collier County calls for every responder to have a predetermined role for cardiac arrests. One person begins manual CPR. Another applies a monitor to the patient's heart. A third prepares the AutoPulse and within seconds slides it around the patient's body so the automated response begins.

Before, sorting through the roles on-site cost time. Now, crews try to let only 45 seconds pass before they start chest compressions, Costello said.

Medics like AutoPulse because it frees up hands and is easier than the physically demanding and sometimes rib-breaking manual cardiopulmonary resuscitation.

"From the field, we really like it," said acting Lt. Ernie Wargo, a fire medic working out of busy Station 14 in the University of South Florida area.

The other four sites testing AutoPulse: Houston, Appleton, Wis., and cities in Austria and the Netherlands. It's unclear why Hillsborough was chosen, but peers in other departments say the agency enjoys a progressive reputation.

Zoll, manufacturer of AutoPulse, has given the county 72 of the $15,000 machines. Each band is disposable and costs $125 to replace. Hillsborough Fire Rescue also gets $149,000 annually for training and personnel costs associated with the trial.

In 2007, the most recent data available, Hillsborough Fire Rescue responded to 455 cardiac arrests. Of those, about 21 percent regained spontaneous circulation — the goal of any CPR.

But studies show that nationally the survival rate is only 2 to 5 percent.

Williams, of Collier County Fire Rescue, said the combination of AutoPulse and the pit crew system has resulted in 40 percent of its patients experiencing spontaneous circulation prior to reaching the hospital — an extraordinary number by most known standards.

Still, Pinellas County, which responds to 900 cardiac arrests per year, has held off on AutoPulse due to expense and lack of consistent research findings.

"We want to be cutting edge, but we don't want to be bleeding edge," said Dr. Laurie Romig, Pinellas County medical director. "I like the concept. I'm not sure the execution is there yet."

Tampa Fire Rescue is holding off for the same reasons, Capt. Bill Wade said.

But Plant City Fire Rescue used grant money to buy two of the devices in 2007 and EMS Chief James Wilson is a fan.

The AutoPulse study Hillsborough is participating in has been vetted by a medical ethics review board as required by federal law. The machine will not be used on children or those with traumatic injuries.

And any patient or family member can choose not to participate, said Hillsborough Rescue Division Chief David Travis.

Rescue crews responding to a cardiac arrest will open a pre-sealed card to determine whether to use manual or automated CPR on the patient.

Costello, Hillsborough's study coordinator, said that he knows about the questions surrounding AutoPulse but that it may offer a chance to save more lives.

"It's a magical moment,'' he said, "when we have someone survive."

Times researcher John Martin contributed to this report. Rebecca Catalanello can be reached at rcatalanello@sptimes.com or (813) 226-3383.

Life or death question: Is man or machine better at CPR? 01/09/09 [Last modified: Sunday, January 11, 2009 7:55pm]

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