Dear ladies and gentlemen Mechanical CPR is of course nothing new but it is currently becoming a lot more popular. For years, developers and engineers have been trying to come up with mechanical solutions that can assist rescuers in applying chest compressions to victims of cardiac arrest. Unfortunately, none of these devices proved to be much help or to have a positive effect on patient’s survival. The entire perspective on this changed when batteries became available that made devices smaller, lighter and allowed longer usage. Together with a regained focus on chest compres- sions during CPR, devices to assist with this life saving procedure became more attainable. A hand full of studies then tried to evaluate the effectiveness of these devices over manual compressions. The majority of these studies concluded that there is no difference regarding survival of patients whether the chest was compressed by a machine or a rescuer. Some even pointed out that the performance of well trained professionals was slightly better. During this time GS corpuls decided to start its own development aiming for a solution which would overcome the restrictions of previous devices and produce ideal chest compressions. Therefore, we had to intensely study which factors influenced better quality chest compres- sions. Interestingly, we found a lot of similarities between optimal mechanical chest compres- sions and high quality manual compressions. One of which is the compression algorithm for example. Whilst healthcare professionals use their upper body weight to compress the chest, mCPR devices should not be too heavy. The upper body weight of the rescuer creates a special squeeze of the heart muscle which can only be created by an mCPR through an increased holding period. The developers of the corpuls cpr were able to reproduce this exact behav- iour with the electrical motor that powers the device. Other similarities include the automatic adjustment to the patient’s chest and the size and shape of the compression disc, which proved to be ideal as it is roughly the same size as a human hand. Since the latest release of the Resuscitation Guidelines 2015, mCPR devices have become more and more popular. This may be because there is a number of patients who benefit from the use of these devices or need them as bridging therapy whilst being transported to the ambulance and onwards to the receiving qualified hospital where they will undergo further treatment such as PCI and/or ECMO. There is a growing number of cases where patients have benefitted from these advantages and this group of patients will hopefully be joined by a very small but even more important group very soon as the corpuls cpr has just been certified to be used on pedi- atric patients above the age of 8 years. Thank you very much and enjoy reading the following articles. Dr. Christian Klimmer CEO Michael Heller Director Medical Research and Application EDITORIAL 3 Dr. Christian Klimmer, CEO Michael Heller, Director MAY | 2018

THE HISTORY OF RESUSCITATION 5 The history of resuscitation The origins of resuscitating unconscious people date back to the time of the Egyptians around 5000 BC and breath- ing techniques were also mentioned in the Old Testament. The work of Galenus of Pergamon, a Greek doctor working predominantly in Rome, influenced human medicine and its development from late antiquity. Discoveries such as the blood circulation by William Harvey in the 17th century laid the foundations for today’s modern medicine. With the establishment of associations such as the Ameri- can Heart Association, the European Resuscitation Council and the German Resuscitation Register, the accompanying professionalisation of the rescue services and numerous re- search projects, the focus shifted from respiration to chest compressions. Today, a 30:2 ratio in favour of chest com- pressions is considered to be the ideal way to ensure ade- quate blood flow to a lifeless person. At first the focus was on the ventilation of the lungs by mouth-to-mouth resuscitation, it was not until the 19th century that a combination of direct or indirect chest com- pressions was used. Here, the Silvester technique roved to be a ground-breaking milestone, which held up in part until the 20th century. Since the 1960s, the industry has been trying to develop mechanical chest compression devices. Due to the inability to downscale the devices, it did not prevail. Only since the turn of the millennium, when it was finally possible to de- sign manageable and practicable devices, have these devices been used increasingly. At the beginning of the 1960s, Peter Safar took decisive steps to demonstrate that the combination of ventilation and chest compressions known today led to significant survival and suc- cess rates. This research was flanked by developments such as bag valve makes and corresponding training, which also made it possible for laymen to learn cardiopulmonary resuscitation. GS Elektromedizinische Geräte G. Stemple GmbH (corpuls) has also been busy developing a chest compression device and intro- duced it under the name corpuls cpr in 2016. Research, experi- ence with the devices currently on the market, current guideline recommendations as well as new ideas and approaches were incorporated into the development of this device. MAY | 2018

CORPULS CPR RESUSCITATION DEVICE GENERATES SUPERIOR EMULATED FLOWS AND PRESSURES THAN LUCAS II IN A MECHANICAL THORAX MODEL 7 corpuls cpr resuscitation device generates superior emulated flows and pressures than LUCAS II in a mechanical thorax model S. Eichhorn1 · A. Mendoza Garcia3 · M. Polski1 · J. Spindler1 · A. Stroh5 · M. Heller4 · R. Lange1, 2 · M. Krane1, 2 1 Department of Cardiovascular Surgery, 4 GS Elektromedizinische Geräte G. Stemple GmbH, Kaufering, Germany Division of Experimental Surgery, German Heart Center Munich, 5 DZHK (German Center for Cardiovascular Research) – 2 Munich Heart Alliance, Lazarettstrasse 36, 80636 Munich, Germany Partner Site Munich Heart Alliance, Munich, Germany 3 Fakultät für Informatik, Robotics and Embedded Systems, Technische Universität München, Munich, Germany Abstract The provision of sufficient chest compression is among the most important factors influencing patient survival during cardiopulmonary resuscitation (CPR). One approach to op- timize the quality of chest compressions is to use mechani- cal-resuscitation devices. The aim of this study was to com- pare a new device for chest compression (corpuls cpr) with an established device (LUCAS II). We used a mechanical tho- rax model consisting of a chest with variable stiffness and an integrated heart chamber which generated blood flow dependent on the compression depth and waveform. The method of blood-flow generation could be changed be- tween direct cardiac-compression mode and thoracic-pump mode. Different chest-stiffness settings and compression modes were tested to generate various bloodflow profiles. Additionally, an endurance test at high stiffness was per- formed to measure overall performance and compression consistency. Both resuscitation machines were able to com- press the model thorax with a frequency of 100/min and a depth of 5 cm, independent of the chosen chest stiffness. Both devices passed the endurance test without difficulty. The corpuls cpr device was able to generate about 10–40% more blood flow than the LUCAS II device, depending on the model settings. In most scenarios, the corpuls cpr device also generated a higher blood pressure than the LUCAS II. The peak compression forces during CPR were about 30% higher using the corpuls cpr device than with the LUCAS II. In this study, the corpuls cpr device had improved blood flow and pressure outcomes over the LUCAS II device. Fur- ther examination in an animal model is required to prove the findings of this preliminary study. Introduction Sudden cardiac arrest is among the most challenging situa- tions in emergency medicine. Sufficient chest compression joins ventilation, early defibrillation and the use of vasopres- sors and antiarrhythmic drugs as the most important factors influencing patient survival. To alleviate provider exhaustion and reduce the need to perform multiple medical procedures at once, the provision of cardiopulmonary resuscitation (CPR) using a mechanical-resuscitation device has been the aim of ongoing projects since the early 1960s [1]. Animal experi- ments and computer simulations have compared manual re- suscitation with CPR using a chestcompression device [2–6]. Mechanical chest-compression devices are able to generate a higher blood flow than manual chest compression in animal models. Efforts to improve mechanical-resuscitation devices, in particular the duty cycle and compression frequency, have yielded varying results [7–11]. Refining these devices is an ambitious process, dealing with compression velocity, duty cycle, energy consumption and potential patient traumati- zation. A new apparatus for mechanical chest compression, the corpuls cpr device, consists of a board positioned under the patient and an adjustable arm containing an electrically driven piston with a duty cycle of 50%. It is designed to give maximum freedom and flexibility to practitioners dur- ing treatment. Devices that use only a single fixed arm face potentially reduced system stability, and compression depth may be not sufficient when treating a patient with signifi- cant chest stiffness. The aim of this study was to compare the newly introduced corpuls cpr device with an established device (LUCAS II) that is used widely in the field. We used a suitable technical model, focusing on compression depth and the generation of blood flow and blood pressure at dif- ferent chest-stiffness settings. Methods We used a mechanical thorax model with adjustable chest stiffness and an internal mechanism capable of generating blood flow corresponding to compression depth and wave- form. The model was able to generate variable chest resist- ance (5–12 N/mm) which corresponds to measurements tak- en in human subjects during resuscitation. The model also integrated a single-chamber heart with a vessel circuit to simulate blood flow. The adjustable stiffness was achieved using 3 pneumatic pistons (ADN-32-100- A-P-A-S11; Festo AG, Esslingen, Germany) which used a constant flow of com- pressed air and a computer-controlled valve (ST4118L0804; Nanotec Electronic GmbH, Feldkirchen, Germany) at the end of the circuit. The model’s chest-plate resistance was regu- lated by adjusting the valve orifice. For more realistic chest recoil, three springs (C = 0.57) were added to the cylinders (0X-DF2091; Febrotec GmbH, Halver, Germany). The model’s stiffness profiles were verified using data from a literature MAY | 2018

CORPULS CPR RESUSCITATION DEVICE GENERATES SUPERIOR EMULATED FLOWS AND PRESSURES THAN LUCAS II IN A MECHANICAL THORAX MODEL 9 scenarios was about 10 mm Hg. Increasing the stamp to the direct-compression mode increased the maximum chamber pressure, and the corpuls cpr device was able to generate a significantly higher (p < 0.001) maximum blood pressure in all scenarios that used the 50 and 70% stamp positions, independent of chest stiffness. The highest difference in maximum blood pressure was recorded in the 50% stamp position. In this scenario, the corpuls cpr device reached ap- proximately a 20% higher peak pressure (~30 mm Hg) than the LUCAS II (~24 mm Hg) at every chest-stiffness value. In the 70% stamp position, the corpuls cpr device generated a pressure (~54 mm Hg) about 8–10% higher than that of the LUCAS II (~49 mm Hg), decreasing with rising chest stiff- ness. Detailed results are provided in Table 2 and Fig. 4. For every chosen model configuration, the corpuls cpr device produced a maximum peak compression force approximate- ly 30% higher than that generated by the LUCAS II device (p < 0.001). The maximum forces generated by the LUCAS II were between 350 and 560 N, with the corpuls cpr device yielding results between 510 and 730 N. These results are presented in Table 3. Discussion Both chest-compression devices were able to compress the mechanical model to a depth of up to 5 cm, with a frequen- cy of 100 compressions per minute and a duty cycle of about 50%, even when a high chest stiffness was used. From the mechanical point of view, the construction of the LUCAS II system, with 2 fastening points and a compression cylinder in the middle of the system frame, provides high stability with little elastic deflection during chest compression. A ma- jor disadvantage of this apparatus is its restricted flexibility in performing additional diagnostic and therapeutic proce- dures due to the cumbersome setting with an unfavorably high balance point. Fig. 2. Model compression and decompression times with different resuscitation devices Fig. 3. Mean flow according to chest resistance and stamp position. Using 20 and 50% Stamp position, the corpuls cpr shows a significantly higher mean flow than LUCAS II (p < 0.001). In 70% stamp position the corpuls cpr shows a marginally higher mean flow than LUCAS II (p < 0.005) ble difference in mean blood flow was observed when the stamp was placed at 20%, representing the thoracic-pump mechanism as the main blood-flow generator. In this scenar- io, the model treated with the corpuls cpr device showed up to double the mean flow of the LUCAS II device, regard- less of chest stiffness (p < 0.001). Increasing the stamp to direct-compression mode led to a decrease in the difference between the generated mean blood flow of the two devic- es. In 50% thoracic-pump/direct-compression mode, the corpuls cpr was still able to generate a mean blood flow that was about 10% higher than the LUCAS II (p < 0.001). When the stamp was increased to 70% (direct-compression mode), the difference in the mean flow shortened by approximate- ly 5% (p < 0.005). Detailed results are given in Fig. 3 and Table 1. When the model was adjusted to the thoracic-pump mode (20% stamp position), there was no significant differ- ence (p> 0.05) in the maximum arterial pressure, regardless of the chosen chest stiffness. The maximum pressure in all The corpuls cpr device consists of a single flexible arm that can be adjusted, using lockable pinjoints, to be appropriate to any patient’s individual situation. This provides the per- sons treating the patient a maximum of flexibility compared with a closed-frame system. However, implementing a CPR machine with an open frame has its challenges. The torque, generated by the compression cylinder at the end of an open frame produces higher bending moments than in a closed frame. Therefore, the mechanical components and pinjoints have to be extremely rigid. We expected a higher compli- ance of the system with high chest stiffness, resulting in re- duced compression depth, but this was not the case. In every chosen scenario, the resuscitation device was able to com- press the model up to a depth of 5 cm. It seems that a slight bending of the frame occurs when the forces generated by the piston increase, but this is compensated by a longer path of the compression cylinder, regulated by an intelligent-con- troller algorithm. A slight difference in the movement speed MAY | 2018

CORPULS CPR RESUSCITATION DEVICE GENERATES SUPERIOR EMULATED FLOWS AND PRESSURES THAN LUCAS II IN A MECHANICAL THORAX MODEL 11 stiffness setting. This result warrants intensive investigation in further studies using a suitable animal model of cardiac arrest. Generating a trapezoidal waveform requires more energy than generating a sinusoidal waveform, causing the device battery to drain more quickly and the motor to heat up during resuscitation. This needs to be addressed with a larger capacity battery and an intelligent motor temperature- management system. Both devices passed the endurance test without difficulty, so we can conclude that energy- and temperature management are efficient in both devices and that both are capable of generating constant compressions. Because of its longer compression duration at a frequency of 100 compressions/minute, the corpuls cpr device compress- es the chest faster than the LUCAS II device, causing higher peak forces. In all model settings, we measured a peak force approximately 30% higher than with the LUCAS II device. Whether these higher peak forces potentially increase the risk of patient trauma cannot be answered by this study; ad- ditional trials with a suitable cadaver model are warranted. Conclusion In examinations using a mechanical thorax model, the corpuls cpr device generates superior blood flow and high- er blood pressure than the LUCAS II device. These results require verification in further studies using suitable animal models. Acknowledgements The examination was also funded by Bayerische Forschungss- tiftung, project “automation of an electrical driven resuscita- tion device, AZ1012-12”. Compliance with ethical standards Conflict of interest Michael Heller is employed at GS Elektromedizinische Geräte G. Stemple GmbH. Ethical approval This article does not contain any studies with human partic- ipants or animals performed by any of the authors. MAY | 2018 Fig. 4. Maximum arterial pressure according to adjusted stamp position. In 20% position, no significant difference in the maximum arterial pressure, generated by the two different devices could be detected (p > 0.05). In 50 and 70% Stamp postion the corpuls cpr was able to generate a highly significant superior maximum arterial pressure than the LUCAS II device (p < 0.001) curve of the chest plate of the model due to compression of the machine was detected between the two devices. A more trapezoidal compression waveform with a longer maximum compression time was seen with the corpuls cpr device. This slight modification in the compression waveform generated greater blood flow in our model. There is no clear consensus on the cause of perfusion during resuscitation. There are two main theories discussed widely in the literature: direct cardi- ac compression [17–20] and the intrathoracic pump mech- anism [21–24]. Depending on the flow-generating effect, either increasing compression frequency or modifying the compression time or duty cycle might result in higher blood flow. If flow generation is mainly influenced by the thoracic pump, prolonging compression time will increase flow. If it is predominantly created by direct compression, increas- ing frequency would thereby increase flow [25]. In our trial, the most prominent difference in flow occurred when the model was tuned to thoracic-pump mode; this is consistent with the measured waveform and findings of several oth- er groups. In an animal study, Kramer-Johansen et al. [26] compared a trapezoidal to a more sinusoidal waveform. The trapezoidal waveform improved the hemodynamics during cardiac arrest, similar to our results. Using a mathematical model developed by our research group, several trapezoidal waveforms at different frequencies result in a peak gener- ated flow at 100 compressions per minute and a prolonged compression of 300 ms [27]. We were able to represent both mechanisms of flow generation, as well as a mixed mecha- nism, in our study. A combination of both effects seems to be the most probable explanation for blood-flow genera- tion. In both the 50 and 70% stamp positions, the corpuls cpr device was able to generate a higher blood pressure and a higher flow than the LUCAS II device, independent of the

CORPULS CPR GENERATES HIGHER MEAN ARTERIAL PRESSURE THAN LUCAS II IN A PIG MODEL OF CARDIAC ARREST 13 corpuls cpr generates higher mean arterial pressure than LUCAS II in a pig model of cardiac arrest S. Eichhorn1 · A. Mendoza3 · A. Prinzing1 · A. Stroh1 · L. Xinghai1 · M. Polski1 · M. Heller5 · H. Lahm1 · E. Wolf4 · R. Lange1, 2 and M. Krane1, 2 1 Clinic for Cardiovascular Surgery, Department of Experimental Surgery, German Heart Center, Munich, Technische Universität München, Germany. 4 Gene Center, LMU Munich, Munich, Germany 5 GS Elektromedizinische Geräte GmbH, Kaufering, Germany 2 DZHK (German Center for Cardiovascular Research) – partner site Munich Heart Alliance, Munich, Germany. 3 Fakultät für Informatik, Robotics and Embedded Systems, Technische Universität München, Germany Correspondence should be addressed to S. Eichhorn; eichhornst@gmail.com Received 15 September 2017; Revised 25 October 2017; Accepted 23 November 2017; Published 17 December 2017 Copyright© 2017 S. Eichhorn et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Academic Editor: Hideo Inaba According to the European Resuscitation Council guidelines, the use of mechanical chest compression devices is a reasonable alternative in situations where manual chest compression is impractical or compromises provider safety.The aim of this study is to compare the performance of a recently developed chest compression device (corpuls cpr) with an established system (LUCAS II) in a pig model. Methods. Pigs (n= 5/group) in provoked ventricular fibrillation were left untreated for 5 minutes, after which 15 min of cardiopulmonary resuscitation was performed with chest compressions. After 15 min, defibrillation was performed every 2 min if necessary, and up to 3 doses of adrenaline were given. If there was no return of spontaneous circulation after 25 min, the experiment was terminated. Coronary perfusion pressure, carotid blood flow, end-expiratory CO2, regional oxygen saturation by near infrared spectroscopy, blood gas, and local organ perfusion with fluorescent labelled microspheres were measured at baseline and during resuscitation. Results. Animals treated with corpuls cpr had significantly higher mean arterial pressures during resuscitation, along with a detectable trend of greater carotid blood flow and organ perfusion. Conclusion. Chest compressions with the corpuls cpr device generated significantly higher mean arterial pressures than compressions performed with the LUCAS II device. Background According to the 2015 European Resuscitation Council (ERC) guidelines, the use of mechanical chest compression devices is a reasonable alternative in situations where manual chest compression is impractical or compromises provider safety. The aim of this study is to compare the performance of a recent- ly developed chest compression device (corpuls cpr) with an established system (LUCAS II) in a pig model of cardiac arrest. Results Animals treated with corpuls cpr had significantly higher mean arterial pressures during resuscitation, along with a detectable trend of greater carotid blood flow and regional organ perfusion. NIRS regional oximetry, local organ perfu- sion measured by microspheres, coronary perfusion pressure and blood gas values showed no difference between the two groups. Methods Pigs (n=5/group) in provoked ventricular fibrillation were left untreated for 5 minutes, after which 15 min of cardi- opulmonary resuscitation (CPR) was performed with chest compressions and a Ruben bag. After 15 min, defibrillation was performed every 2 min if necessary, and up to 3 doses of adrenaline were given. If there was no return of spon- taneous circulation (ROSC) after 25 min, the experiment was terminated. Coronary perfusion pressure (CPP), carotid blood flow, end expiratory CO2, regional oxygen saturation by near infrared spectroscopy (NIRS), blood gas, and local organ perfusion with fluorescent labelled microspheres were measured at baseline and during resuscitation. Conclusion Chest compressions with the corpuls cpr device generated significantly higher mean arterial pressures than compres- sions performed with the LUCAS II device, along with a slight increase in carotid flow. No differences could be detected concerning CPP, local organ perfusion or local oxygen satu- ration measured with NIRS. MAY | 2018

CORPULS CPR GENERATES HIGHER MEAN ARTERIAL PRESSURE THAN LUCAS II IN A PIG MODEL OF CARDIAC ARREST 15 tion, as follows: 106 microspheres /10 kg body weight were injected via the pigtail catheter, which was directly above the aortic valve, and reference samples were taken via syringe pump over a catheter placed in the decending aorta at a rate of 10 mL/min for 4 minutes. Before initiation of ventricular fibrillation, the pigs were ran- domised into two groups, corpuls cpr (CCPR) or LUCAS II CPR, by a sealed envelope method. Pigs that received corpuls cpr were secured to a v-shaped board prior to induc- tion of ventricular fibrillation and those that were treated with the LUCAS II device were secured inside the device by padding on the left and right sides between the pig and the load frame (Fig. 1). Resuscitation was performed according to the protocol out- lined in Fig 1. Ventricular fibrillation was induced by a 14 V direct current pulse via the pacemaker and the pigs were left untreated for 5 min. The respirator was disconnected and the infusion of propofol and fentanyl was stopped. After 5 min, CPR was initiated. Both devices were operating with 100 com- pressions /min in continuous mode and a compression depth of 50 mm with a duty cycle 50%. 10 ventilations per minute were performed with a Ruben bag supplied with 100% oxygen. The fluorescent microspheres were injected at 5 min of resus- citation. After 15 min of continuous resuscitation the com- pressions were stopped and defibrillation was performed with a 150 J biphasic impulse in cases of ongoing ventricular fibril- lation. Compressions were then resumed for 2 min, and up to 3 doses of epinephrine (0.01 mg/kg mg) were given after 3 cycles of 2 min chest compression after defibrillation. If there was no return of spontaneous circulation (ROSC) after 6 defibrillations and 3 doses of epinephrine the experiment was stopped. Necropsies were performed with special attention to compression-related chest injuries that might have affected ROSC (Pericardial Effusion, Pneumothorax, Hemothorax). Blood gas samples were collected every 5 min after initiation of cardiac arrest; the sampling included lactate measurement by Siemens Rapid Point 500 (Siemens, Erlangen, Germany). Cardiac perfusion pressure (CPP) was calculated according to the end diastolic method [13] using an average of 10 com- pression cycles. Mean arterial pressure (MAP), mean carotid blood flow (CBF), regional oxygen saturation (%RO2) by NIRS, and end expiratory CO2 (ETCO2) were also measured to eval- uate the performance of the resuscitation devices. The data was recorded continuously using powerlab and Labchart (AD Instruments, Sydney, Australia). For evaluation, Baseline data before initiation of ventricular fibrillation, 5 minutes of cardiac arrest and during resuscitation (1; 5; 10; 15; 20 minutes) were taken. Normal distribution of the data was analysed using the Kol- mogorov-Smirnov test. Comparison of variables between the 2 groups was performed with student´s t-test for unpaired observations. A p-value of <0.05 was regarded as an indicator of statistically significant differences between the groups. All statistical analyses were carried out using IBM SPSS V20. Fig. 1: Left side: Pig in a v-shaped board during treatment with the corpuls cpr, Right side: Pig fixed with cushions in the LUCAS II. Lower side: Description of the study protocol, MS: Microsphere injection, BG: Blood Gas sample, D: Defibrillation, A: Administration of adrenaline. MAY | 2018

CORPULS CPR GENERATES HIGHER MEAN ARTERIAL PRESSURE THAN LUCAS II IN A PIG MODEL OF CARDIAC ARREST 17 Table 2 Mean arterial pressure, local Perfusion, Et CO2 and carotid blood flow during resuscitation MAP [mm Hg] MAP 1 minute MAP 5 minutes MAP 10 minutes MAP 15 minutes MAP 20 minutes corpuls cpr 49.4 ± 7.58 42.2 ± 7.11 45.6 ± 13.7 43.4 ± 9.2 43.2 ± 10.7 LUCAS II 25.9 ± 6.53 25,54 ± 6.53 23.0 ± 6.7 21.6 ± 6.4 21.9 ± 6.6 CBF [ml/min] CBF 1 minute CBF 5 minutes CBF 10 minutes CBF 15 minutes CBF 20 minutes corpuls cpr 26.6 ± 8.45 26.4 ± 5.68 24.0 ± 3.85 18.8 ± 4.7 18.2 ± 4.8 LUCAS II 20.82 ± 8.01 18.9 ± 9.34 15.5 ± 8.43 11.66 ± 5.21 6.48 ± 3.23 Et CO2 [mmHg] Et CO2 1 minute Et CO2 5 minutes Et CO2 10 minutes Et CO2 15 minutes Et CO2 20 minutes corpuls cpr 22.62 ± 9.27 34.6 ± 25.76 23.1 ± 12.64 17.68 ± 7.08 15.94 ± 8.42 LUCAS II 22.58 ± 5.49 22.88 ± 9.31 22.84 ± 10.5 19.88 ± 9.96 15.9 ± 4.17 Local Perfusion at 5 min Brain [ml/min100g] Heart [ml/min100g] Kidney [ml/min100g] Liver [ml/min100g] corpuls cpr 8.24 ± 2.17 25 ± 8.39 45 8 ± 18.5 3.4 ± 2.06 LUCAS II 4.54 ± 2.41 18.8 ± 1.94 46.6 ± 11.3 2.24 ±0.73 MAP: Mean arterial pressure. *Mean arterial pressure was significantly higher in the corpuls cpr group throughout the entire resuscitation period. CBF: Carotid blood flow. *Carotid blood flow was significantly higher in the corpuls cpr group at 20 min. Discussion The haemodynamic parameters at baseline and during resusci- tation in our experiments corresponded with the results of pre- vious evaluations of mechanical resuscitation devices. Halperin et al. [6] generated CPP between 14 and 21 mm Hg, cerebral flow of approximately 0.2 mL/min/g, and MAP of approximate- ly 36 mmHg during CPR using a load distributing band (Auto- pulse). Steen et al. [7], in an evaluation of a LUCAS device, measured CBF of approximately 30% of baseline and MAP of approximately 40 mmHg, and Liao et al [14] reported CPP of >20 mmHg and a CBF of approximately 30 to 35% of base- line during CPR with the LUCAS II device in pig models. The LUCAS II system is presently the most widely used mechanical chest compression system, and a number of experiments and clinical trials have been performed to evaluate its efficacy [15- 20]. Therefore, we used the LUCAS II system as the reference device for comparison with the corpuls cpr device. We found that the corpuls device was able to generate a sig- nificantly higher MAP than the LUCAS device. There was also a trend to greater CBF and improved local organ perfusion with the corpuls device, although this was not statistically significant. On the other hand, corpuls cpr produces a slightly more trap- ezoidal compression waveform than the LUCAS II device. Us- ing an artificial chest model with integrated blood flow we could measure the compression waveform of the two devices and produce analogue results concerning MAP and arteri- al blood flow comparing the LUCAS II and the corpuls cpr [9] . Kramer-Johansen et al. [1] have reported similar results secondary to modifications of the compression waveform in a computer simulation as well as in a pig model. There are two effects that are mentioned in Literature causing blood cir- culation during CPR, the direct cardiac compression and the thoracic pump theory [21, 22]. If the flow is predominantly created by the thoracic pump, a more trapezoid compression waveform with prolonged compression time will increase the flow. In the chest of a pig the ventricles are embedded with loung tissue from all sides, and the compressions given to the thorax are affecting the heart and the big vessels much more by the thoracic pump mechanism, than by the direct com- pression mechanism than in humans [14]. This might also be an explanation that although having similar cardiac perfusion pressures in the group of corpuls cpr a higher MAP could be generated. The ability of corpuls cpr to generate higher MAP and CBF might be related to a difference in the compression waveform [9], or to the different shape of the chest compression plate. Nei- ther of the compression plates that were used in our experiments have a feature for active chest recoil, and the diameters of the contact areas are comparable. Thus, the difference in flow and pressure is probably not related to the compression plate. In a study performed by Paradis et al. [23] only patients with a CPP of 15 mm Hg or higher reached ROSC. Similar findings for pigs were obtained by Steen et al. [7] .In our study, CPP values of >15 mmHg were reached in all animals during CPR, and there were no signs of pericardial effusion or pneumothorax at necropsy that would have been affecting ROSC. However, none of the animals had ROSC. In a pig model with a compa- MAY | 2018

CORPULS CPR GENERATES HIGHER MEAN ARTERIAL PRESSURE THAN LUCAS II IN A PIG MODEL OF CARDIAC ARREST 19 early defibrillation and administration of antiarrhythmic drugs or vasopressors would have most likely increased the rate of ROSC in our study. Peak forces of up to 600 N have been reported during chest compression [29-31]. The frame of a resuscitation device must be very rigid to reach a compression depth of 50 mm. Exami- nation of the recorded data of the LUCAS II device used in 59 cases of cardiac arrest by Beesems et al. [32] showed that the LUCAS II device was able to generate sufficient compression of 50 mm in all cases. There was initial concern that the flexible open frame of the corpuls cpr. Device would not have sufficient rigidity to en- sure proper compression depths in different chest profiles. In previous experiments based on a mechanical chest model [9] and in the animal experiments, there were no difficulties reach- ing the recommended compression depth of 50 mm with the corpuls device in any case, and no immoderate bending or moving of the stamp on the compression area was noted. Several studies have been performed to determine the useful- ness of NIRS as a neuromonitoring tool for prediction of out- comes, detection of ROSC, or evaluation of the quality of brain perfusion during CPR [33]. We found a significant difference in %RO2 between baseline, after 5 min of cardiac arrest, and after 5 min of CPR. We also found a very high level of interindi- vidual deviation of the absolute values of %RO2, which might indicate, that the chosen sensor system that was designed for the human brain is not suitable for examination in pigs. Fig. 3: Mean arterial pressure and carotid bloodflow during resuscitation (* =p<0.05). corpuls cpr is generating a significantly higher mean arterial pressure during the whole resuscitation period. Carotid blood flow seems to be higher by trend during the resuscitation period, after 20 minutes of resuscitation a significant difference could be detected. We were using the smallest available paediatric sensors for NIRS monitoring, which are designed for human use. The di- mensions of the skull and brain of the pig are anatomically different than those of the human, and this might explain the large interindividual spread of the recorded values. In our opinion, in experiments with a pig model, submental sensor placement is preferable to frontal region placement for moni- toring cerebral perfusion. We found that the most impressive changes with the least interindividual deviation were detected when the sensors were placed in the submental position. This might be due to better adaption of the sensor to the tissue in the submental region, as the plane area for correct sensor placement in the frontal region is limited. We were able to use NIRS to measure baseline oxygen satura- tion values before cardiac arrest. The usefulness of information obtained from NIRS measurements during resuscitation might be limited without prior baseline measurements, as is often the case in real world emergency situations. Nonetheless, our results support the conceptual premise that regional oxygen saturation can detect changes in cerebral perfusion brain dur- ing CPR. Whether this method is suitable to predict ROSC or the neurological outcome, as other authors have suggested [34, 35], or whether it can provide further information regard- ing the quality of CPR, cannot be finally answered based on the design and results of our study. Further investigations fo- cusing especially on the use of NIRS in CPR are necessary. MAY | 2018

Literature 1. Kramer-Johansen J, Myklebust H, Wik L, et al. Quality of out-of-hos- pital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study. Resuscitation 2006; 71:283-292. 2. Wik L, Kramer-Johansen J, Myklebust H, et al. Quality of cardiopul- monary resuscitation during out-of-hospital cardiac arrest. JAMA 2005; 293:299-304. 3. Putzer G, Braun P, Zimmermann A, et al. LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue-a prospective, randomized, cross-over manikin study. Am J Emerg Med 2013; 31:384-389. 4. Harrison-Paul R Resuscitation great. A history of mechanical devices for providing external chest compressions. Resuscitation 2007; 73:330-336. 5. Timerman S, Cardoso LF, Ramires JA, et al. Improved hemodynamic performance with a novel chest compression device during treatment of in-hospital cardiac arrest. Resuscitation 2004; 61:273-280. 6. Halperin HR, Paradis N, Ornato JP, et al. Cardiopulmonary resuscitation with a novel chest compression device in a porcine model of cardiac arrest: improved hemodynamics and mechanisms. J Am Coll Cardiol 2004; 44:2214-2220. 7. Steen S, Liao Q, Pierre L, et al. Evaluation of LUCAS, a new device for automatic mechanical compression and active decompression resuscitation. Resuscitation 2002; 55:285-299. 8. Monsieurs KG, Nolan JP, Bossaert LL, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. 9. Eichhorn S, Mendoza Garcia A, Polski M, et al. Corpuls cpr resuscitation device generates superior emulated flows and pressures than LUCAS II in a mechanical thorax model. Australas Phys Eng Sci Med 2017; 40:441-447. 10. GS Elektromedizinische Geräte G. Stemple Gmbh corpuls cpr. https://corpuls.world/en/products/corpuls-cpr 11. Prinzing A, Eichhorn S, Deutsch MA, et al. Cardiopulmonary resuscitation using electrically driven devices: a review. J Thorac Dis 2015; 7:E459-467. 12. Swindle MM, Smith AC Best practices for performing experimental surgery in swine. J Invest Surg 2013; 26:63-71. 13. Otlewski MP, Geddes LA, Pargett M, et al. Methods for calculating coronary perfusion pressure during CPR. Cardiovasc Eng 2009; 9:98-103. 14. Liao Q, Sjoberg T, Paskevicius A, et al. Manual versus mechanical cardiopulmonary resuscitation. An experimental study in pigs. BMC Cardiovasc Disord 2010; 10:53. 15. Gates S, Quinn T, Deakin CD, et al. Mechanical chest compression for out of hospital cardiac arrest: Systematic review and meta-analysis. Resuscitation 2015; 94:91-97. 16. Gates S, Smith JL, Ong GJ, et al. Effectiveness of the LUCAS device for mechanical chest compression after cardiac arrest: systematic review of experimental, observational and animal studies. Heart 2012; 98:908-913. 17. Perkins GD, Lall R, Quinn T, et al. Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. Lancet 2015; 385:947-955. 18. Anantharaman V, Ng BL, Ang SH, et al. Prompt use of mechanical cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the MECCA study report. Singapore Med J 2017; 58:424-431. CORPULS CPR GENERATES HIGHER MEAN ARTERIAL PRESSURE THAN LUCAS II IN A PIG MODEL OF CARDIAC ARREST 21 compressions and simultaneous defibrillation vs conventional cardiopul- 19. Rubertsson S, Lindgren E, Smekal D, et al. Mechanical chest monary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial. JAMA 2014; 311:53-61. 20. Tranberg T, Lassen JF, Kaltoft AK, et al. Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest before and after introduction of a mechanical chest compression device, LUCAS-2; a prospective, observational study. Scand J Trauma Resusc Emerg Med 2015; 23:37. 21. Criley JM, Niemann JT, Rosborough JP, et al. The heart is a conduit in CPR. Crit Care Med 1981; 9:373-374. 22. Kouwenhoven WB, Jude JR, Knickerbocker GG Landmark article July 9, 1960: Closed-chest cardiac massage. By W. B. Kouwenhoven, James R. Jude, and G. Guy Knickerbocker. JAMA 1984; 251:3133-3136. 23. Paradis NA, Martin GB, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA 1990; 263:1106-1113. 24. Wagner H, Madsen Hardig B, Steen S, et al. Evaluation of coronary blood flow velocity during cardiac arrest with circulation maintained through mechanical chest compressions in a porcine model. BMC Cardiovasc Disord 2011; 11:73. 25. Martin TG, Hawkins NS, Weigel JA, et al. Initial treatment of ventricular fibrillation: defibrillation or drug therapy. Am J Emerg Med 1988; 6:113-119. 26. Weaver WD, Copass MK, Bufi D, et al. Improved neurologic recovery and survival after early defibrillation. Circulation 1984; 69:943-948. 27. Gu W, Hou X, Li C Effect of different resuscitation strategies on post-re- suscitation brain damage in a porcine model of prolonged cardiac arrest. Chin Med J (Engl) 2014; 127:3432-3437. 28. Indik JH, Shanmugasundaram M, Allen D, et al. Predictors of resusci- tation outcome in a swine model of VF cardiac arrest: A comparison of VF duration, presence of acute myocardial infarction and VF wave - form. Resuscitation 2009; 80:1420-1423. 29. Bankman IN, Gruben KG, Halperin HR, et al. Identification of dynamic mechanical parameters of the human chest during manual cardiopulmo- nary resuscitation. IEEE Trans Biomed Eng 1990; 37:211-217. 30. Gruben KG, Guerci AD, Halperin HR, et al. Sternal force-displacement relationship during cardiopulmonary resuscitation. J Biomech Eng 1993; 115:195-201. 31. Neurauter A, Nysaether J, Kramer-Johansen J, et al. Comparison of mechanical characteristics of the human and porcine chest during cardi- opulmonary resuscitation. Resuscitation 2009; 80:463-469. 32. Beesems SG, Hardig BM, Nilsson A, et al. Force and depth of mechan- ical chest compressions and their relation to chest height and gender in an out-of-hospital setting. Resuscitation 2015; 91:67-72. 33. Genbrugge C, Dens J, Meex I, et al. Regional Cerebral Oximetry During Cardiopulmonary Resuscitation: Useful or Useless? J Emerg Med 2016; 50:198-207. 34. Asim K, Gokhan E, Ozlem B, et al. Near infrared spectrophotometry (cerebral oximetry) in predicting the return of spontaneous circulation in out-of-hospital cardiac arrest. Am J Emerg Med 2014; 32:14-17. 35. Parnia S, Nasir A, Shah C, et al. A feasibility study evaluating the role of cerebral oximetry in predicting return of spontaneous circulation in cardiac arrest. Resuscitation 2012; 83:982-985. MAY | 2018

PRACTICAL AID FOR EFFORTLESS RESUSCITATION? USER REPORT “CORPULS CPR” 23 operation, the device has a battery life of about 90 min- utes, which should cover most scenarios. If a longer resus- citation is required, a quick battery replacement is possible also mains power supply (12 V and 220 V) can be used. These characteristics make the corpuls cpr an appropriate resuscitation aid in special situations such as prolonged re- suscitation (e.g. during systemic lysis therapy) or during the transport of patients in order not to endanger personnel and to ensure sufficient resuscitation despite centrifugal/inertial forces while driving. Trial operation in the district of Gütersloh In the district of Gütersloh about 220 resuscitation attempts are carried out by the rescue service every year. Of these, about 100 people reach a hospital and about 20 of them under ongoing resuscitation. Devices from Zoll Medical and Physio Control were also tested here a few years ago. The trial run with two corpuls cpr devices took place from 29.12.2015 to 16.4.2016. During the study period, there were 57 missions with preclinical cardiopulmonary resuscita- tion, of which 21 people reached a hospital with a Return of Spontaneous Circulation (ROSC). 70 % of the resuscitations took place in the home environment. 11 patients were treat- ed with one of the corpuls cpr devices during this period. Of these, one patient with ROSC reached the hospital. Of the 11 patients, seven were transported to the hospital under resuscitation; here the corpuls cpr presumably contribut- ed to the safety of the personnel. In all of these patients, a longer resuscitation phase was bridged until further thera- py. Of course, it should be noted that the corpuls cpr has only been tested on a handful of patients over a limited time period. Therefore, no long-term conclusions can be drawn from this. Conclusion Mechanical chest compression devices can, under certain conditions, be of great help to rescue service personnel. However, it is important to consider the medical facts/prog- noses and ethics: Even if a resuscitation with this technique can be carried out more or less “effort-free”, the decision regarding the subsequent death of the patient should be based on the same criteria as with a “normal” resuscitation. If transport under ongoing resuscitation is required, a me- chanical compression aid may be useful from the point of view of personnel safety alone as the Emergency Physician and Paramedic / Critical Care Paramedic can be seated and belted in while driving. The “corpuls cpr” system proved itself during the test period in the district of Gütersloh and was hence purchased for all five doctor cars. This text is a short version of the article “Practical aid for effortless resuscitation? User report corpuls cpr”. Published in the magazine RETTUNGSDIENST 10/2016 Literature 1. Deutsches Reanimationsregister (2016) Jahresstatistik präklinische Datenerfassung 2015 – Standortkennung Kreis Gütersloh – Deutsches Reanimationsregister. Erstellt 29.3.2016 2. Soar J, Nolan J, Böttiger B et al. (2015) Erweiterte Reanimations maßnahmen für Erwachsene (..adult advanced life support”) – Kapitel 3 der Leitlinien zur Reanimation 201 5 des European Resuscitation Council. Notfall Rettungsmed 18: 770 3. Ca llaway CW, Soar J, Aibiko M et al. (2015) 20 15 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations – Part 4: Advanced Life Support. Circulation 132: S84-S 145 MAY | 2018

THE CORPULS CPR USER TEST – INTERVIEW MISSION INVESTIGATION WITH CORPULS.WEB REVIEW 25 has been proven to improve organ perfusion and thus the probability of survival. If the device has been properly ap- plied, this leaves one more assistant to perform other tasks (e.g. drug delivery and such). Additionally, the doctor and Emergency Paramedics / Critical Care Paramedics can sit buckled in while driving and not run the risk of injuring themselves unnecessarily in the event of sudden braking or cornering. Manual compression quality suffers considerably even on an accident-free journey. RETTUNGSDIENST: What potential problems do you see using this tech- nology? Strickmann: It is important to be aware that an already deceased patient is not transported to the emergency room. In my opinion, this device allows for good chest compression over a long period of time, providing that it is necessary - it does not work wonders on patients who have been dead for a long time. Therefore, it must not be tempting to artificially pro- long the medical and ethical decision on patient death sim- ply because you can perform resuscitation with the device with less effort. In addition, good training is essential - the device does not mean you are not required to check your own and other processes again and again. Therefore, for example the position of the device must be checked often. RETTUNGSDIENST: How do you rate your experience with the corpuls cpr? Strickmann: The corpuls cpr is in my opinion a very suitable device for chest compressions, providing that the indication for a longer-lasting resuscitation was made. As it the case, for ex- ample, with preclinical lysis. The design also makes it faster in our experience than other devices as it consists of just a board and an arm with a punch. This eliminates a strap as with other devices. The manufacturer’s waiving of dispos- able items also ensures fast and constant readiness for use and the elimination of sourcing errors. Mission investigation with corpuls.web REVIEW The corpuls cpr continuously stores all settings and sensor data during patient treatment. This includes compression depths and rates as selected by the user at each point in time, as well as movement and force feedback values during each individual compression. The free software tool corpuls.web REVIEW provides the ability to gain insights into this data. The entire mission is displayed as a scrollable timeline, showing compressions, settings, pauses and events. Debriefings and CPR trainings among other things can be significantly improved by con- sulting the recorded real-time data – also the patient file can create PDF reports from the corpuls cpr, safeguarding the resuscitation team in the case of complaint proceedings. Additional insights on a larger scale can be obtained via the companion server software corpuls.web ANALYSE. Impor- tant questions about CPR quality and device usage can be quickly answered using the entire set of recorded missions. Key performance indicators can be displayed on the data analytics dashboards. This solution can help to improve the CPR quality and other measures for the entire organisation. Fig. 1: corpuls.web REVIEW, Screenshot MAY | 2018

REGISTRY STUDY ON RESUSCITATION 27 COMPRESS – COMPARING OBSERVATIONAL MULTI-CENTRE PROSPECTIVE Introduction COMPRESS Abstract Past studies with various mechanical chest compression devices have demonstrated the safety of these such devices. Al- though no superiority has been proven so far, but rather an equivalence in the comparison of manual chest compression to devices, these devices can guarantee high-quality compressions over a longer period of time. (Gässler et al. 2016) Proof of the safety and efficacy of comparable devices has already been shown in existing interventional studies with strong evidence. (Luxen et al. 2015) Therefore, the COMPRESS study on the corpuls® cpr is designed to monitor that the findings thus far also apply to this device. Additionally, questions and patient groups for which there is little or no evidence to date are investigated. (Bernhard et al. 2016) Literature Bernhard, Michael; Hossfeld, Bjorn; Kumle, Bernhard; Becker, Torben K.; Böttiger, Bernd geräte. Aktueller Stand und mögliche Einsatzgebiete. W.; Birkholz, Torsten (2016): Don’t forget to ventilate during cardiopulmonary resuscita- tion with mechanical chest compression devices. In: European Journal of Anaesthesiology. DOI: 10.1097/EJA.0000000000000426. Der Notarzt 3 • 2016. In: Der Notarzt 32 (3), S. 130–139. DOI: 10.1055/s-0042-107181. Luxen, J. P.; Birkholz, Torsten; Hatz, A.; Kanz, K.-G.; Königer, J.; Meier, M. et al. (2015): Nutzen mechanischer Reanimationshilfen bei der kardiopulmonalen Reanimation. In: Gässler, Holger; Helm, Matthias; Lampl, L. (2016): Mechanische Thoraxkompressions- Notfall Rettungsmed 18 (2), S. 119–129. DOI: 10.1007/s10049-014-1956-2. COMPRESS – Comparing Observational Multi-Centre Prospective Registry Study on Resuscitation S. Dopfer1 · B. Jakisch2 · J. Wnent2, 3 · M. Heller1 J.-T. Gräsner2, 3 Institut für Rettung- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein 1 GS Elektromedizinische Geräte G. Stemple GmbH, Medical Research and Application 2 3 Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel O N R E S U S C I T A T I O N Literature 1. Gässler H, Helm M, Lampl L: Mechanische Thoraxkompressionsgeräte: Aktueller Stand und mögliche Einsatzgebiete. Der Notarzt 3 • 2016. Der Notarzt 2016;32(3):130-9. doi: 10.1055/s-0042-107181 2. Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T, et al: European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015;95:81-99. doi: 10.1016/j. resuscitation.2015.07.015. PubMed PMID: 2647742. 3. Bernhard M, Hossfeld B, Kumle B, Becker TK, Böttiger BW, Birkholz T: Don’t forget to ven - tilate during cardiopulmonary resuscitation with mechanical chest compression devices. Eur J Anaesthesiol 2016. doi: 10.1097/EJA. 0000000000000426. PubMed PMID: 26854661 Objective Since its introduction in 2015, the corpuls cpr has pio- neered a new generation of mechanical chest compression devices. This is due to its extraordinary flexibility in terms of adaptability to patient needs and usage situations. While large studies have investigated the clinical benefits of com- parable devices, currently there is a lack of similar studies for the corpuls cpr [1]. Therefore, this study analyses the criteria of high quality chest compressions according to the 2015 ERC Guidelines [2]. In addition, ventilation parameters and resuscitation-related injuries are also analysed to exam- ine both the safety and performance of the device and the safety of the patient. Minors up to the end of their 18th year of age, adults from the end of their 18th year of age until the end of their 65th year of age and adults from the end of their 65th year of age. Within the respective age group, a distinction is made between the group of manually resuscitated patients and patients in whom the corpuls cpr was also used. Results The results will be published after the final analysis at the end of the three-year collection period. After half of the col- lection period, an interim analysis of the data collected to that point will be carried out. Method For this multi-centre observational study, routine data on re- suscitation missions is gathered in several preclinical centres over a period of three years and collected in the German Resuscitation Registry. The patients are divided into different groups based on their age and the form of treatment. Interpretation In addition to the goal of monitoring the clinical perfor- mance of the corpuls cpr, the study offers the potential to investigate other factors. Particular attention will be paid to the resuscitation of pediatric patients and ventilation strate- gy and quality [3]. MAY | 2018

CORPULS CPR – A UNIQUE DEVICE 29 compression depth is ensured even with longer usage. If automatic compensation is no longer possible in the current position, the user is informed optically and acoustically that the device needs to be repositioned. tomatically releases when removed from the bag. The re- maining running time is shown to the user on the display in minutes. The design concept of the arm extending above the patient ensures clear access to the thorax at all times. Offering, among other things, more possibilities for imaging in the cath lab and constant access to and vision of electrodes. The arm can be placed at four different positions: to the right and left of the head and to the right and left of the lower thorax. With a battery life of 90 minutes, the corpuls cpr guaran- tees uninterrupted therapy. This is particularly useful in the preclinical setting, where often long transport times to a suitable treatment facility must be bridged. If the battery life is insufficient, it can be replaced in seconds with a second battery. Also, charging via 220V and 12V is possible - even during therapy or while in the transport bag. Connection to the mains power supply is via a magnetic plug, that au- Using the 2.4” colour display as well as the four softkeys, numerous parameters can be set, or device information called up. For example, regarding therapy parameters - the mode (15:2; 30:2; continuous), compression depth (2 - 6cm) and compression frequency can be changed. These can be permanently stored in the device as a standard setting and can also be changed during therapy. Also, shortcuts allow the display to be inverted or rotated without having to open the menu. For preclinical use, the IP54 dust and splash proof rating and the wide operating temperature range of -20°C to +45°C are an advantage. Ensuring the corpuls cpr can be used under the most adverse conditions. Numerous accessories are available for use with the corpuls cpr. Versatile accessories Quadboard Recboard Designed for clinical use, the Quadboard is radiolucent and easy to disinfect. Thanks to the big handle it can be quickly positioned under the patient. The Recboard was developed for preclinical use. Together with the specially developed attachment straps and the Fixation Ring, it can be securely fixed to all common stretcher systems. MAY | 2018

CORPULS CPR – A UNIQUE DEVICE 31 LED backlighting -20 °C to +45 °C General Specifications: • Color display 2.4‘‘ with • Operating temperature: • Dust and splash proof (IP54) • Power supply: 12-33V DC • Operating noise: 70 dB • Data interface: SD card • • RTCA DO 160 G (emc tested) (on-board power), 110-240V AC (Mains 50-60 Hz) Integrated alarm management stamp / battery: 45 x 43 x 9 cm / 5.5 kg Dimensions and weights: • corpuls cpr arm with • Recboard: • Quadboard: • Scoopboard: 46 x 46 x 13 cm / 1.7 kg 45 x 35 x 83 cm / 1.6 kg 47 x 47 x 3.5 cm / 2.2 kg MAY | 2018 Specifications Compression parameters: • Compression rate: 80 to 120 compressions per minute (adjustable in increments of 1 compression per minute) • Compression depth: 2-6 cm (adjustable in increments of 0.1 cm) • Therapy mode: 30:2 / 15:2 / continuous (secure airway) Patient parameters: • Chest Height: 14 to 34 cm • No restrictions on the width of • No restriction on the weight • 8 years and older of the patient the patient 20% increments Operating parameters: • Power source: electric • Battery: Lithium Polymer (LiPo) • Operating time 90 minutes (typical) • Displays the remaining run time in minutes • LED indication of battery charge level in • Battery charging time • • Simultaneous display of operating mode, compression depth, compression rate, time / therapy time and remaining runtime of the battery shown in minutes and percentage • At least 300 charging cycles (via magnetic connector, no therapy): 105 min 0-80% 30 min 80-100% Intuitive user interface: Therapy start/stop button with alarm and 4 softkeys Find out more on www.corpuls.world