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

Henrik Wagner

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

Kardiologi

Forskningsoutput: Avhandling › Doktorsavhandling (sammanläggning)

Sammanfattning

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.

Originalspråk	engelska
Kvalifikation	Doktor
Tilldelande institution	Kardiologi
Handledare	Erlinge, David, handledare Madsen Härdig, Bjarne, handledare Olivecrona, Göran, handledare
Tilldelningsdatum	2015 apr. 17
Förlag	Department of Cardiology, Clinical sciences, Lund University
ISBN (tryckt)	978-91-7619-114-9
Status	Published - 2015

Bibliografisk information

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.

---

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%

Ämnesklassifikation (UKÄ)

Kardiologi

3 Artikel i vetenskaplig tidskrift

Repeated epinephrine doses during prolonged cardiopulmonary resuscitation have limited effects on myocardial blood flow: a randomized porcine study
Wagner, H., Götberg, M., Hardig, B. M., Rundgren, M., Carlson, J., Götberg, M., Sparv, D., Erlinge, D. & Olivecrona, G., 2014, I: BMC Cardiovascular Disorders. 14, 199.
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

Öppen tillgång
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160 Nedladdningar (Pure)
Evaluation of coronary blood flow velocity during cardiac arrest with circulation maintained through mechanical chest compressions in a porcine model
Wagner, H., Hardig, B. M., Steen, S., Sjoberg, T., Harnek, J. & Olivecrona, G., 2011, I: BMC Cardiovascular Disorders. 11
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

Fil
206 Nedladdningar (Pure)
Cardiac arrest in the catheterisation laboratory: A 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts.
Wagner, H., Terkelsen, C. J., Friberg, H., Harnek, J., Kern, K., Lassen, J. F. & Olivecrona, G., 2010, I: Resuscitation. 81, s. 383-387
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

1 Aktiva

Helsingborgs HLR och Kardiovaskulära forskningsgrupp
Madsen Härdig, B. (PI), Wagner, H. (Biträdande handledare), Siotis, A. (Forskarstuderande), Dolata, C. D. (Forskarstuderande) & Åkerman, A. (Forskarstuderande)
2021/02/01 → …
Projekt: Forskning

Citera det här

@phdthesis{ac6c6e695e2a40c692b160645d4d6fca,

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

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{\texttrademark} 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.",

keywords = "Cardiac arrest, mechanical chest compressions, PCI, survival, coronary artery blood flow, epinephrine",

author = "Henrik Wagner",

note = "Defence details Date: 2015-04-17 Time: 13:00 Place: Auditorium 5, Centralblocket, Sk{\aa}ne University Hospital, Lund. External reviewer(s) Name: Nordrehaug, Jan Erik Title: Professor Affiliation: Klinisk Institut II, Haukelands University Hospital, Bergen, Norway. --- 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%",

year = "2015",

language = "English",

isbn = "978-91-7619-114-9",

series = "Faculty of Medicine, Lund University, Sweden/Dissertation.",

publisher = "Department of Cardiology, Clinical sciences, Lund University",

type = "Doctoral Thesis (compilation)",

school = "Cardiology",

}

TY - THES

T1 - Clinical and experimental insights into the use of mechanical chest compressions during prolonged resuscitation in the coronary catheterization laboratory

AU - Wagner, Henrik

N1 - 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. --- 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%

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

KW - Cardiac arrest

KW - mechanical chest compressions

KW - PCI

KW - survival

KW - coronary artery blood flow

KW - epinephrine

M3 - Doctoral Thesis (compilation)

SN - 978-91-7619-114-9

T3 - Faculty of Medicine, Lund University, Sweden/Dissertation.

PB - Department of Cardiology, Clinical sciences, Lund University

ER -

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

Sammanfattning

Bibliografisk information

Ämnesklassifikation (UKÄ)

Fingeravtryck

Forskningsoutput

Repeated epinephrine doses during prolonged cardiopulmonary resuscitation have limited effects on myocardial blood flow: a randomized porcine study

Evaluation of coronary blood flow velocity during cardiac arrest with circulation maintained through mechanical chest compressions in a porcine model

Cardiac arrest in the catheterisation laboratory: A 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts.

Projekt

Helsingborgs HLR och Kardiovaskulära forskningsgrupp

Citera det här