Riverside County Halts Use of CPR Machine

Riverside County health officials have suspended use of a federally approved CPR machine after a man who was treated with the device suffered cracked ribs and internal injuries and later died, authorities said.

Paramedics from the Palm Springs Fire Department used the “AutoPulse” cardiac support pump to resuscitate Fang Joon Yun, 77, after he was pulled from a swimming pool July 14. After Yun was revived, he was taken to a local hospital, where he was pronounced dead, Riverside County sheriff’s officials said.

A Riverside County medical examiner found that “something was not right” while performing Yun’s preliminary autopsy, said Sheriff Bob Doyle, who oversees the county coroner’s office.

“We put the device back on the individual, and it lined up exactly with where the broken ribs and other injuries he had suffered,” Doyle said, stressing that Yun’s cause of death had yet to be determined.

Six hundred AutoPulse devices are being used by rescue providers in San Francisco, Fremont, Calif., and other cities throughout the country, although it is not in use in Los Angeles or Orange counties, company officials said.

Because of the medical examiner’s findings, the Riverside County Emergency Medical Services Agency suspended use of the device in the county until Yun’s case could be further investigated. Michael Osur, director of the agency, said he had alerted emergency agencies using the device throughout the state.

“We don’t know if that particular machine was defective or if the design itself is faulty, but until we can figure out how [Yun’s injuries occurred], it is not to be used,” Osur said.

Bob Katz, chief operating officer of Sunnyvale, Calif.-based Revivant Corp., manufacturer of AutoPulse, said he was told that the device had been cleared in Yun’s death. Revivant is a subsidiary of Zoll Medical Corp. of Massachusetts.

“We’ve been told from the coroner’s office that the AutoPulse really isn’t in any way related to the drowning,” said Katz. “The coroner has reported that the cause of death was asphyxiation, as secondary to drowning. Palm Springs Fire [said] that it was clear to everyone.”

Katz and several other medical officials added that when cardiopulmonary resuscitation is performed manually, ribs are often broken from the direct pressure that is applied to the chest.

The AutoPulse is designed to avoid that by distributing pressure throughout the torso. If manual CPR is performed before the AutoPulse is used by rescuers, the cause of the injury is most likely the manual CPR, Katz said.

Doyle said he planned to schedule a coroner’s review of Yun’s death, a special hearing conducted for unique or suspicious deaths. He said it was premature for AutoPulse officials to discuss Yun’s cause of death.

“I wouldn’t take what they say as an official word,” Doyle said. “We’ll do our investigation.”

Palm Springs Fire Chief Blake Goetz said his agency recently put the AutoPulse device into use and that city emergency personnel had undergone extensive training by the manufacturer. He added that the device was “successful” in reviving Yun and he hoped that “we will be using this device again.”

Goetz declined to provide any more specifics about the case.

Likened to a lightweight life-jacket, the AutoPulse system is made up of a belted vest with a motorized chest compressor. Manual CPR requires great strength and two emergency medical technicians. The AutoPulse requires just one rescuer, to regulate the breathing apparatus, freeing up other personnel, according to Katz and information made available by the company.

The Food and Drug Administration approved the current version of the AutoPulse device for use in March 2004.

The San Francisco Fire Department has used the device the last few years, responding to more than 400 calls with its life-saving abilities. Dr. Amy Hart, chief medical examiner of the city and county of San Francisco, says that of the cases she has examined, usually suspicious deaths, no problems similar to that of the Palm Springs case have been reported.

Hart said Yun’s age or a possible medical condition may have played a role in his injuries.

Katz said that of the AutoPulses in use throughout the nation, only “a few” have had problems similar to that in Yun’s case.

In each case, as will be with the Palm Springs death, the AutoPulse is brought back to the company and assessed for defects. Katz said no faults had been found with any devices and that the company had been cleared in all cases of injury or death.