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

Wagner, Henrik LU (2015) In Faculty of Medicine, Lund University, Sweden/Dissertation. 2015:35.
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... (More)
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. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Nordrehaug, Jan Erik, Klinisk Institut II, Haukelands University Hospital, Bergen, Norway.
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Cardiac arrest, mechanical chest compressions, PCI, survival, coronary artery blood flow, epinephrine
in
Faculty of Medicine, Lund University, Sweden/Dissertation.
volume
2015:35
pages
109 pages
publisher
Department of Cardiology, Clinical sciences, Lund University
defense location
Auditorium 5, Centralblocket, Skåne University Hospital, Lund.
defense date
2015-04-17 13:00
ISSN
1652-8220
ISBN
978-91-7619-114-9
language
English
LU publication?
yes
id
ac6c6e69-5e2a-40c6-92b1-60645d4d6fca (old id 5323084)
date added to LUP
2015-04-27 09:26:03
date last changed
2016-09-19 08:44:49
@phdthesis{ac6c6e69-5e2a-40c6-92b1-60645d4d6fca,
  abstract     = {INTRODUCTION. Prolonged cardiopulmonary resuscitation (CPR) with manual chest compressions (CC) during<br/><br>
simultaneous percutaneous coronary intervention (PCI) is exceedingly difficult, with high mortality rates. The use of a<br/><br>
mechanical CC (MCC) device can overcome the ordeal of manual CC. The aims of this thesis were to investigate the<br/><br>
impact of the introduction of the LUCAS™ MCC device in the cath-lab (Papers I and II); to develop a structured<br/><br>
approach in advanced CPR during simultaneous PCI (Paper III); to study myocardial perfusion and blood flow during<br/><br>
MCC with and without EPI (Papers IV and V).<br/><br>
MATERIAL and METHODS. A retrospective analysis (5 years) and a prospective follow up study (4 years) with patients<br/><br>
treated with MCC during simultaneous PCI were performed. Circumstances leading to the cardiac arrest, and patient<br/><br>
and PCI outcomes were investigated (Papers I and II). A structured physiology-guided CPR approach during<br/><br>
simultaneous PCI was developed (Paper III). In both animal studies (Papers IV and V) circulation was maintained with<br/><br>
MCC during ventricular fibrillation. Coronary blood flow (APV) and coronary perfusion pressure (CPP) were analysed<br/><br>
(Papers IV and V), with the addition of amplitude spectrum area (AMSA) in Paper V. The animals in Paper V were<br/><br>
randomised to four injections of EPI or saline (control) during the MCC period.<br/><br>
RESULTS. Forty-three patients were included in Paper I and 32 patients in Paper II. Twenty-five percent were<br/><br>
discharged from hospital in good neurological condition in each study. Seventy-six percent (Paper I) and 81% (Paper II)<br/><br>
were successfully treated with PCI. In Paper III, the development of a structured physiology-guided CPR approach in<br/><br>
the cath-lab led to better CPR teamwork during the CPR effort. Coronary artery APV was good throughout the MCC<br/><br>
period with a good correlation to CPP (Paper IV). In Paper V, epinephrine significantly increased CPP in 3/4 injections;<br/><br>
APV was increased only after the first injection, and no increase was seen in AMSA.<br/><br>
CONCLUSIONS. The use of MCC during prolonged CPR has been shown to be feasible, safe, with good PCI results,<br/><br>
and can save lives. Mechanical chest compressions can maintain normal coronary blood flow in the experimental<br/><br>
laboratory. Epinephrine decreases myocardial circulation despite increased CPP.},
  author       = {Wagner, Henrik},
  isbn         = {978-91-7619-114-9},
  issn         = {1652-8220},
  keyword      = {Cardiac arrest,mechanical chest compressions,PCI,survival,coronary artery blood flow,epinephrine},
  language     = {eng},
  pages        = {109},
  publisher    = {Department of Cardiology, Clinical sciences, Lund University},
  school       = {Lund University},
  series       = {Faculty of Medicine, Lund University, Sweden/Dissertation.},
  title        = {Clinical and experimental insights into the use of mechanical chest compressions during prolonged resuscitation in the coronary catheterization laboratory},
  volume       = {2015:35},
  year         = {2015},
}