Clinical and experimental insights into the use of mechanical chest compressions during prolonged resuscitation in the coronary catheterization laboratory

University dissertation from Department of Cardiology, Lund Universiry

Abstract: INTRODUCTION. Prolonged cardiopulmonary resuscitation (CPR) with manual chest compressions (CC) during simultaneous percutaneous coronary intervention (PCI) is exceedingly difficult, with high mortality rates. The use of a mechanical CC (MCC) device can overcome the ordeal of manual CC. The aims of this thesis were to investigate the impact of the introduction of the LUCAS™ MCC device in the cath-lab (Papers I and II); to develop a structured approach in advanced CPR during simultaneous PCI (Paper III); to study myocardial perfusion and blood flow during MCC with and without EPI (Papers IV and V). MATERIAL and METHODS. A retrospective analysis (5 years) and a prospective follow up study (4 years) with patients treated with MCC during simultaneous PCI were performed. Circumstances leading to the cardiac arrest, and patient and PCI outcomes were investigated (Papers I and II). A structured physiology-guided CPR approach during simultaneous PCI was developed (Paper III). In both animal studies (Papers IV and V) circulation was maintained with MCC during ventricular fibrillation. Coronary blood flow (APV) and coronary perfusion pressure (CPP) were analysed (Papers IV and V), with the addition of amplitude spectrum area (AMSA) in Paper V. The animals in Paper V were randomised to four injections of EPI or saline (control) during the MCC period. RESULTS. Forty-three patients were included in Paper I and 32 patients in Paper II. Twenty-five percent were discharged from hospital in good neurological condition in each study. Seventy-six percent (Paper I) and 81% (Paper II) were successfully treated with PCI. In Paper III, the development of a structured physiology-guided CPR approach in the cath-lab led to better CPR teamwork during the CPR effort. Coronary artery APV was good throughout the MCC period with a good correlation to CPP (Paper IV). In Paper V, epinephrine significantly increased CPP in 3/4 injections; APV was increased only after the first injection, and no increase was seen in AMSA. CONCLUSIONS. The use of MCC during prolonged CPR has been shown to be feasible, safe, with good PCI results, and can save lives. Mechanical chest compressions can maintain normal coronary blood flow in the experimental laboratory. Epinephrine decreases myocardial circulation despite increased CPP.

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