LAUSR

The 2015 European Resuscitation Council1 guidelines suggest hat automated chest compression (A-CPR) devices should not outinely replace manual chest compressions. They also suggest hat A-CPR devices are a reasonable alternative to high-quality anual chest compressions in situations where sustained highuality manual compressions are impossible, impractical or might ompromise provider safety such as in a moving ambulance, in ase of prolonged CPR attempts and for cardiopulmonary resusitation during certain procedures such as coronary angiography, lthough these specific use cases are not in evidence in the literaure referenced.1 We suggest explicitly designating in-hospital cardiac arrest as a eason for early A-CPR and would like to argue this point. In-hospital survival has not improved in line with out-ofospital (OOH) survival. While many factors may contribute, the bility of staff to perform “high quality” compressions per se,5 and he mechanics of chest compressions in hospital beds or stretchrs remain points of discussion.2 Any non-rigid support surfaces dversely affects quality of chest compressions and mattress makes epth estimation difficult. A CPR-board reduces mattress displaceent, but does not alleviate it, placement takes time, and it effects he use of feedback devices.3,4 Resuscitation in beds seems a speial case since “high quality” compressions cannot be guaranteed r monitored. A-CPR studies to date have focused on out-of-hospital resusciations. Studies which included A-CPR showed late and prolonged eployment times.1,5 For hospitals, response teams typically bring heir own resources and are on scene quickly. As we have done for ome years now, upgrading manual to A-CPR at team arrival allows -CPR to be started within the critical 6-min window, something ot achieved in the OOH studies. While A-CPR will, unavoidably, till follow an initial period of manual chest compressions, early lacement can absorb the set-up hands-off time in the transition rom basic to advanced teams, and minimize further compression nterruptions.3,5 In-hospital teams do not have the manpower limtations found in OOH resuscitations. The value-add of A-CPR is projected onto its reproducible, tireess, high quality compressions. The investment is in hands-off time uring placement. The in-hospital environment is ideal to manage his, as lengthy resuscitations, movement of patients to cath labs, ltrasound and invasive monitoring, all occur. A well-drilled team and a clear intern protocol seem crucial to se A-CPR devices correctly. In the Elisabeth-TweeSteden Hospital e have invested in this with training and an intern protocol (Fig. 1).