SMEAR Classification of Cardiopulmonary Resuscitation Techniques and Devices

Author(s): Muhammad Feras Iftikhar, Linta Iftikhar, Shahzad Hassan

Cardiopulmonary resuscitation (CPR) is a widely practiced lifesaving skill. Conventional CPR is based on manual chest compressions and delivering mouth-to-mouth breaths. There has been advancement in biomedical technology over the last few decades which has led to the introduction of new techniques and devices in CPR as well. In light of these advancements, we propose SMEAR (Standard, Mechanical, ECMO Assisted, augmented virtual and Remote) classification system to provide structured overview from traditional to novel methods and devices. The standard or Manual CPR, widely practiced by the general public during out-of-hospital cardiac arrests, combines active chest compressions with or without mouth breathing. However, to enhance CPR’s efficacy, various mechanical devices have been developed, encompassing Active Chest Compression, Passive Decompression, and those integrated with Automated External Defibrillators. Feedback sensor-equipped devices, include the Metronome, Accelerometer, Barometer, and Triaxial Field Induction. Mechanical devices, classified by their compression mechanisms, can be isolated – like the Piston-driven, Load-distributing, and Active Compression-Decompression (ACD) – or combined, as in ACD-ITV (Impedance Threshold Device), ACD-IAC (Interposed Abdominal Compression), and ACD-ITV-EECP (Enhanced External Counter Pulsation). Beyond mechanics, Extracorporeal CPR offers veno-arterial Extracorporeal Membrane Oxygenation in refractory cardiac arrest and can improve outcomes. Augmented Virtual Reality usage in training and provision of CPR is at the early stages. It has the potential of expanded usage in training public to provide high-quality CPR. A provider can be remotely guided step by step via telephone or smartphone applications, ensuring continuous support until professional assistance arrives.