Feasibility and safety of automated chest compression during helicopter rescue with hoisting

Out-of-hospital cardiac arrest (OHCA) in mountainous environments presents substantial logistical challenges, particularly in maintaining high-quality chest compressions during helicopter evacuations. Prolonged interruptions, especially during hoisting, may critically impact neurological outcomes. This study aimed to assess the feasibility and effectiveness of a mechanical chest compression (MCC) device compared to manual compressions during a simulated helicopter hoisting scenario. This was a prospective, crossover simulation study involving complete mountain rescue teams. Each team completed two scenarios: one using an MCC device (LUCAS-3®) and one using manual chest compressions. Hoisting was performed at two heights (15 m and 30 m). The primary outcome was chest compression fraction (CCF). Secondary outcomes included, compression depth and rate, and overall safety of the procedure. Results are reported as mean ± standard deviation. CCF was significantly higher in the MCC group compared to the manual group (96.6% ± 0.3 vs. 73.9% ± 6.6; p = 0.03). Compression rate was more consistently maintained within recommended ranges (103.0 ± 1.41 cpm vs 136.5 ± 8.66 cpm; p < 0.001). The guidelines-recommended range for chest compressions was significantly higher with the MCC device (89.5% ± 9.6 vs 7.5% ± 6.3; p = 0.03). No adverse safety events were observed. In a simulated mountain rescue setting, the use of a mechanical chest compression device during helicopter hoisting appears feasible, safe and seems to improve chest compression fraction and the rate of guideline-compliant chest compressions.