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. 2019 Jan 8;8(1):e011189.
doi: 10.1161/JAHA.118.011189.

LUCAS Versus Manual Chest Compression During Ambulance Transport: A Hemodynamic Study in a Porcine Model of Cardiac Arrest

Aurora Magliocca  1   2 , Davide Olivari  1 , Daria De Giorgio  1 , Davide Zani  3 , Martina Manfredi  3 , Antonio Boccardo  3 , Alberto Cucino  1   4 , Giulia Sala  3 , Giovanni Babini  1   4 , Laura Ruggeri  1 , Deborah Novelli  1 , Markus B Skrifvars  5 , Bjarne Madsen Hardig  6 , Davide Pravettoni  3 , Lidia Staszewsky  1 , Roberto Latini  1 , Angelo Belloli  3 , Giuseppe Ristagno  1
Affiliations

LUCAS Versus Manual Chest Compression During Ambulance Transport: A Hemodynamic Study in a Porcine Model of Cardiac Arrest

Aurora Magliocca et al. J Am Heart Assoc. .

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 CO2 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 CO2 were significantly higher with mechanical CC compared with manual CC (coronary perfusion pressure: 43±4 versus 18±4 mmHg; end-tidal CO2: 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.

Keywords: ambulance transport; cardiac arrest; cardiopulmonary resuscitation; chest compression resuscitation; manual cardiopulmonary resuscitation; mechanical cardiopulmonary resuscitation.

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Figures

Figure 1
Figure 1
On the top: a flowchart of the study protocol. On the bottom: a view of the ambulance cabin with an ongoing mechanical chest compression on the left and manual CC on right. CC indicates chest compression; epi, epinephrine administration; ROSC, return of spontaneous circulation; VF, ventricular fibrillation.
Figure 2
Figure 2
Coronary perfusion pressure, end tidal CO2, and arterial lactate levels (Lac) at baseline, during cardiopulmonary resuscitation, and after return of spontaneous circulation. BL indicates baseline; CPP, coronary perfusion pressure; EtCO2, end tidal CO2; Lac, arterial lactate levels; ROSC, return of spontaneous circulation. *P<0.05, † P<0.01 vs manual chest compression.
Figure 3
Figure 3
Systolic (SAP) and diastolic (DAP) arterial pressure, and right atrial pressure (RAP) at baseline, during cardiopulmonary resuscitation, and after return of spontaneous circulation. BL indicates baseline; DAP, diastolic arterial pressure; RAP, right atrial pressure; ROSC, return of spontaneous circulation; SAP, systolic arterial pressure. *P<0.05, † P<0.01 vs manual chest compression.
Figure 4
Figure 4
LUCAS (on the left) and manual (on the right) chest compression‐generated transthoracic impedance signal (in green) and corresponding arterial pressure (in orange) during cardiopulmonary resuscitation performed in static condition (on the top) and in the moving ambulance (on the bottom). The graphs on the right represent the CC‐generated transthoracic impedance variability in the LUCAS in the manual chest compression during the static condition (on the top) and the ambulance transport (on the bottom). CC indicates chest compression. *P<0.01 vs manual chest compression.
See this image and copyright information in PMC

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