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

Research output: ThesisDoctoral Thesis (compilation)

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 (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.
Original languageEnglish
QualificationDoctor
Awarding Institution
  • Cardiology
Supervisors/Advisors
  • Erlinge, David, Supervisor
  • Madsen Härdig, Bjarne, Supervisor
  • Olivecrona, Göran, Supervisor
Award date2015 Apr 17
Publisher
ISBN (Print)978-91-7619-114-9
Publication statusPublished - 2015

Bibliographical note

Defence details

Date: 2015-04-17
Time: 13:00
Place: Auditorium 5, Centralblocket, Skåne University Hospital, Lund.

External reviewer(s)

Name: Nordrehaug, Jan Erik
Title: Professor
Affiliation: Klinisk Institut II, Haukelands University Hospital, Bergen, Norway.

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Errata in Dissertation

page 15 line 7: 0.22% should be 0.0022%

page 16 line 6: Class IIb LOE C should be LOE A

page 37 Animal preparation methods line 2: Weight range (28 – 31) should be (28 – 33)

page 62 Table 7 : 10 mmHg should be 15 mmHg

Page 79 discussion line 4: 0.64% should be 0.0064%

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Keywords

  • Cardiac arrest
  • mechanical chest compressions
  • PCI
  • survival
  • coronary artery blood flow
  • epinephrine

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