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

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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.


  • 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
External organisations
  • Mario Negri Institute for Pharmacological Research
  • University of Milan
  • Helsinki University Central Hospital
  • Jolife AB
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

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


  • Ambulance transport, Cardiac arrest, Cardiopulmonary resuscitation, Chest compression resuscitation, Manual cardiopulmonary resuscitation, Mechanical cardiopulmonary resuscitation
Original languageEnglish
Article numbere011189
JournalJournal of the American Heart Association
Issue number1
Publication statusPublished - 2019 Jan 1
Publication categoryResearch
Externally publishedYes

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