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LUCAS versus manual chest compression during ambulance transport : A hemodynamic study in a porcine model of cardiac arrest

Magliocca, Aurora ; Olivari, Davide ; De Giorgio, Daria ; Zani, Davide ; Manfredi, Martina ; Boccardo, Antonio ; Cucino, Alberto ; Sala, Giulia ; Babini, Giovanni and Ruggeri, Laura , et al. (2019) In Journal of the American Heart Association 8(1).
Abstract


Background—Mechanical chest compression (CC) is currently suggested to deliver sustained high-quality CC in a moving ambulance. This study compared the hemodynamic support provided by a mechanical piston device or manual CC during ambulance transport in a porcine model of cardiopulmonary resuscitation. Methods and Results—In a simulated urban ambulance transport, 16 pigs in cardiac arrest were randomized to 18 minutes of mechanical CC with the LUCAS (n=8) or manual CC (n=8). ECG, arterial and right atrial pressure, together with end-tidal CO
2
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Background—Mechanical chest compression (CC) is currently suggested to deliver sustained high-quality CC in a moving ambulance. This study compared the hemodynamic support provided by a mechanical piston device or manual CC during ambulance transport in a porcine model of cardiopulmonary resuscitation. Methods and Results—In a simulated urban ambulance transport, 16 pigs in cardiac arrest were randomized to 18 minutes of mechanical CC with the LUCAS (n=8) or manual CC (n=8). ECG, arterial and right atrial pressure, together with end-tidal CO
2
and transthoracic impedance curve were continuously recorded. Arterial lactate was assessed during cardiopulmonary resuscitation and after resuscitation. During the initial 3 minutes of cardiopulmonary resuscitation, the ambulance was stationary, while then proceeded along a predefined itinerary. When the ambulance was stationary, CC-generated hemodynamics were equivalent in the 2 groups. However, during ambulance transport, arterial and coronary perfusion pressure, and end-tidal CO
2
were significantly higher with mechanical CC compared with manual CC (coronary perfusion pressure: 43±4 versus 18±4 mmHg; end-tidal CO
2
: 31±2 versus 19±2 mmHg, P<0.01 at 18 minutes). During cardiopulmonary resuscitation, arterial lactate was lower with mechanical CC compared with manual CC (6.6±0.4 versus 8.2±0.5 mmol/L, P<0.01). During transport, mechanical CC showed greater constancy compared with the manual CC, as represented by a higher CC fraction and a lower transthoracic impedance curve variability (P<0.01). All animals in the mechanical CC group and 6 (75%) in the manual one were successfully resuscitated. Conclusions—This model adds evidence in favor of the use of mechanical devices to provide ongoing high-quality CC and tissue perfusion during ambulance transport.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ambulance transport, Cardiac arrest, Cardiopulmonary resuscitation, Chest compression resuscitation, Manual cardiopulmonary resuscitation, Mechanical cardiopulmonary resuscitation
in
Journal of the American Heart Association
volume
8
issue
1
article number
e011189
publisher
Wiley-Blackwell
external identifiers
  • pmid:30590977
  • scopus:85059243550
ISSN
2047-9980
DOI
10.1161/JAHA.118.011189
project
Helsingborg Resuscitation and Cardiovascular Research Group
language
English
LU publication?
no
id
913f4909-6dfa-4899-a22a-b68c5c234f0e
date added to LUP
2019-05-22 11:48:21
date last changed
2024-05-28 11:36:14
@article{913f4909-6dfa-4899-a22a-b68c5c234f0e,
  abstract     = {{<p><br>
                                                         Background—Mechanical chest compression (CC) is currently suggested to deliver sustained high-quality CC in a moving ambulance. This study compared the hemodynamic support provided by a mechanical piston device or manual CC during ambulance transport in a porcine model of cardiopulmonary resuscitation. Methods and Results—In a simulated urban ambulance transport, 16 pigs in cardiac arrest were randomized to 18 minutes of mechanical CC with the LUCAS (n=8) or manual CC (n=8). ECG, arterial and right atrial pressure, together with end-tidal CO                             <br>
                            <sub>2</sub><br>
                                                          and transthoracic impedance curve were continuously recorded. Arterial lactate was assessed during cardiopulmonary resuscitation and after resuscitation. During the initial 3 minutes of cardiopulmonary resuscitation, the ambulance was stationary, while then proceeded along a predefined itinerary. When the ambulance was stationary, CC-generated hemodynamics were equivalent in the 2 groups. However, during ambulance transport, arterial and coronary perfusion pressure, and end-tidal CO                             <br>
                            <sub>2</sub><br>
                                                          were significantly higher with mechanical CC compared with manual CC (coronary perfusion pressure: 43±4 versus 18±4 mmHg; end-tidal CO                             <br>
                            <sub>2</sub><br>
                                                         : 31±2 versus 19±2 mmHg, P&lt;0.01 at 18 minutes). During cardiopulmonary resuscitation, arterial lactate was lower with mechanical CC compared with manual CC (6.6±0.4 versus 8.2±0.5 mmol/L, P&lt;0.01). During transport, mechanical CC showed greater constancy compared with the manual CC, as represented by a higher CC fraction and a lower transthoracic impedance curve variability (P&lt;0.01). All animals in the mechanical CC group and 6 (75%) in the manual one were successfully resuscitated. Conclusions—This model adds evidence in favor of the use of mechanical devices to provide ongoing high-quality CC and tissue perfusion during ambulance transport.                         <br>
                        </p>}},
  author       = {{Magliocca, Aurora and Olivari, Davide and De Giorgio, Daria and Zani, Davide and Manfredi, Martina and Boccardo, Antonio and Cucino, Alberto and Sala, Giulia and Babini, Giovanni and Ruggeri, Laura and Novelli, Deborah and Skrifvars, Markus B. and Hardig, Bjarne Madsen and Pravettoni, Davide and Staszewsky, Lidia and Latini, Roberto and Belloli, Angelo and Ristagno, Giuseppe}},
  issn         = {{2047-9980}},
  keywords     = {{Ambulance transport; Cardiac arrest; Cardiopulmonary resuscitation; Chest compression resuscitation; Manual cardiopulmonary resuscitation; Mechanical cardiopulmonary resuscitation}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{LUCAS versus manual chest compression during ambulance transport : A hemodynamic study in a porcine model of cardiac arrest}},
  url          = {{http://dx.doi.org/10.1161/JAHA.118.011189}},
  doi          = {{10.1161/JAHA.118.011189}},
  volume       = {{8}},
  year         = {{2019}},
}