Continuous mechanical chest compression during in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activity.
Survival after in-hospital pulseless electrical activity (PEA) cardiac arrest is poor and has not changed during the last 10 years. Effective chest compressions may improve survival after PEA. We investigated whether a mechanical device (LUCAS™-CPR) can ensure chest compressions during cardiac arrest according to guidelines and without interruption during transport, diagnostic procedures and in the catheter laboratory.


METHODS
We studied mechanical chest compression in 28 patients with PEA (pulmonary embolism (PE) n=14; cardiogenic shock/acute myocardial infarction; n=9; severe hyperkalemia; n=2; sustained ventricular arrhythmias/electrical storm; n=3) in a university hospital setting.


RESULTS
During or immediately after CPR, 21 patients underwent coronary angiography and or pulmonary angiography. Successful return of a spontaneous circulation (ROSC) was achieved in 27 out of the 28 patients. Ten patients died within the first hour and three patients died within 24h after CPR. A total of 14 patients survived and were discharged from hospital (13 without significant neurological deficit). Interestingly, six patients with PE did not have thrombolytic therapy due to contraindications. CT-angiography findings in these patients showed fragmentation of the thrombus suggesting thrombus breakdown as an additional effect of mechanical chest compressions. No patients exhibited any life-threatening device-related complications.


CONCLUSIONS
Continuous chest compression with an automatic mechanical device is feasible, safe, and might improve outcomes after in-hospital-resuscitation of PEA. Patients with PE may benefit from effective continuous chest compression, probably due to thrombus fragmentation and increased pulmonary artery blood flow.
Klinik für Innere Medizin III, Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Kiel 24105, Germany. hendrik.bonnemeier@uk-sh.de
Hendrik
H
Bonnemeier
Gregor
G
Simonis
Göran
G
Olivecrona
Britta
B
Weidtmann
Matthias
M
Götberg
Gunther
G
Weitz
Ivana
I
Gerling
Ruth
R
Strasser
Norbert
N
Frey
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D055724:Electrophysiological Phenomena; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011674:Pulse