title: Mechanical chest compressions improve rate of return of spontaneous circulation and allow for initiation of percutaneous circulatory support during cardiac arrest in the cardiac catheterization laboratory.
abstract: Performing advanced cardiac life support (ACLS) in the cardiac catheterization laboratory (CCL) is challenging. Mechanical chest compression (MCC) devices deliver compressions in a small space, allowing for simultaneous percutaneous coronary intervention and reduced radiation exposure to rescuers. In refractory cases, MCC devices allow rescuers to initiate percutaneous mechanical circulatory support (MCS) and extracorporeal life support (ECLS) during resuscitation. This study sought to assess the efficacy and safety of MCC when compared to manual compressions in the CCL.
  
  
  
  We performed a retrospective analysis of patients who received ACLS in the CCL at our institution between May 2011 and February 2016. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual and mechanical compressions.
  
  
  
  Forty-three patients (67% male, mean age 58 years) required chest compressions for cardiac arrest while in the CCL (12 manual and 31 MCC). Patients receiving MCC were more likely to achieve return of spontaneous circulation (ROSC) (74% vs. 42%, p=0.05). Of those receiving MCC, twenty-two patients (71%) were treated with MCS. Patients receiving percutaneous ECLS were more likely to achieve ROSC (100% vs. 53%, p=0.003) and suffered no episodes of limb loss or TIMI major bleeding. There were no significant differences in 30-day survival or survival to hospital discharge between groups.
  
  
  
  Use of MCC during resuscitation of cardiac arrest in the CCL increases the rate of ROSC. Simultaneous implantation of MCS, including percutaneous ECLS, is feasible and safe during MCC-assisted resuscitation in the CCL.
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Venturini
authors.affiliation: Centegra Health System, 360 North Terra Cotta, Crystal Lake, IL 60012, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Retzer
authors.affiliation: MaineHealth Cardiology, Maine Medical Partners, 96 Campus Drive, Scarborough, ME 04074, USA.
authors.forename: J Raider
authors.initials: JR
authors.lastname: Estrada
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Friant
authors.affiliation: Section of Emergency Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
authors.forename: David
authors.initials: D
authors.lastname: Beiser
authors.affiliation: Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Edelson
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Paul
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
authors.forename: John
authors.initials: J
authors.lastname: Blair
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA. Electronic address: Ashah@bsd.uchicago.edu.
authors.forename: Atman P
authors.initials: AP
authors.lastname: Shah
mesh_terms: D000368:Aged; D001775:Blood Circulation / Q000502:physiology*; D006328:Cardiac Catheterization / Q000009:adverse effects; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies
keywords: Acute cardiac life support; Chest compressions; Extracoporeal life support; Mechanical chest compressions; Percutaneous coronary intervention