title: Mechanical chest compressions in the coronary catheterization laboratory to facilitate coronary intervention and survival in patients requiring prolonged resuscitation efforts.
abstract: BACKGROUND
  Resuscitation after cardiac arrest (CA) in the catheterization laboratory (cath-lab) using mechanical chest compressions (CC) during simultaneous percutaneous coronary intervention (PCI) is a strong recommendation in the 2015 European Resuscitation Council (ERC) guidelines. This study aimed at re-evaluating survival to hospital discharge and assess long term outcome in this patient population.
  
  
  METHODS
  Patients presenting at the cath lab with spontaneous circulation, suffering CA and requiring prolonged mechanical CC during cath lab procedures between 2009 and 2013 were included. Circumstances leading to CA, resuscitation parameters and outcomes were evaluated within this cohort. For comparison, patients needing prolonged manual CC in the cath lab in the pre-mechanical CC era were evaluated. Six-month and one year survival with a mechanical CC treatment strategy from 2004 to 2013 was also evaluated.
  
  
  RESULTS
  Thirty-two patients were included between 2009 and 2013 (24 ST-elevation myocardial infarction (STEMI), 4 non-STEMI, 2 planned PCI, 1 angiogram and 1 intra-aortic counter pulsation balloon pump insertion). Twenty were in cardiogenic shock prior to inclusion. Twenty-five were successfully treated with PCI. Median mechanical CC duration for the total cohort (n = 32) was 34 min (range 5-90), for the 15 patients with circulation discharged from the cath-lab, 15 min (range 5-90), and for the eight discharged alive from hospital, 10 min (range 5-52). Twenty-five percent survived with good neurological outcome at hospital discharge. Ten patients treated with manual CC were included with one survivor.
  
  
  CONCLUSIONS
  Eighty-seven percent of the patients included in the mechanical CC cohort had their coronary or cardiac intervention performed during mechanical CC with an 80 % success rate. This shows that the use of mechanical CC during an intervention does not seem to impair the interventional result substantially. The survival rate after one year was 87 %.
  
  
  CONCLUSIONS
  Among patients suffering CA treated with mechanical CC in the cath-lab, 25% had a good neurological outcome at hospital discharge compared to 10% treated with manual CC. Long term survival in patients discharged from hospital is good.
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden. henrik.wagner@med.lu.se.
authors.forename: Henrik
authors.initials: H
authors.lastname: Wagner
authors.affiliation: Physio-Control Sweden/Jolife AB, Lund, Sweden. bjarne.madsen.hardig@physio-control.com.
authors.forename: Bjarne Madsen
authors.initials: BM
authors.lastname: Hardig
authors.affiliation: Department of Anaesthesiology and Intensive Care, Lund University, Lund, Sweden. malin.rundgren@med.lu.se.
authors.forename: Malin
authors.initials: M
authors.lastname: Rundgren
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden. david.zughaft@med.lu.se.
authors.forename: David
authors.initials: D
authors.lastname: Zughaft
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden. jan.harnek@med.lu.se.
authors.forename: Jan
authors.initials: J
authors.lastname: Harnek
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden. matthias.gotberg@med.lu.se.
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden. goran.olivecrona@med.lu.se.
authors.forename: Göran K
authors.initials: GK
authors.lastname: Olivecrona
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002404:Catheterization; D035641:Chest Wall Oscillation / Q000295:instrumentation*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012189:Retrospective Studies; D013534:Survival