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

Aurora Magliocca, Davide Olivari, Daria De Giorgio, Davide Zani, Martina Manfredi, Antonio Boccardo, Alberto Cucino, Giulia Sala, Giovanni Babini, Laura Ruggeri, Deborah Novelli, Markus B. Skrifvars, Bjarne Madsen Hardig, Davide Pravettoni, Lidia Staszewsky, Roberto Latini, Angelo Belloli, Giuseppe Ristagno

Research output: Contribution to journalArticlepeer-review

25 Citations (SciVal)

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 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.

Original languageEnglish
Article numbere011189
JournalJournal of the American Heart Association
Volume8
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1
Externally publishedYes

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems
  • Other Medical Sciences not elsewhere specified

Keywords

  • Ambulance transport
  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Chest compression resuscitation
  • Manual cardiopulmonary resuscitation
  • Mechanical cardiopulmonary resuscitation

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