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LUCAS™ in the cath lab

Duration: 2 min 29 sec.

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Sometimes a PCI is "not only a PCI"

LUCAS™ has proven to be an appreciated tool in the catheterisation laboratory (cath lab) (1, 2, 3, 4). This is where myocardial infarction patients are treated with stents and balloons in order to restore the coronary blood flow.

In the infrequent, but catastrophic cases of therapy-resistent cardiac arrest during a procedure, e.g. due to a sudden and abrupt occlusion of a major coronary artery, defibrillation alone is not able to revers the arrest. The best alternative often is to continue the intervention during CPR (cardiopulmonary resuscitation).

However, providing manual CPR on a patient who is lying on the cath lab table is exceedingly difficult, for practical, efficacy and safety reasons. With LUCAS compressions, circulation is sustained without compromising rescuer/patient safety or continued intervention.

LUCAS CPR works well during fluoroscopy, catheterization and PCI

LUCAS™ is mostly radio-translucent except for the hood and compression mechanism. Most radiological projection angles can be used during LUCAS CPR, something which is not possible during manual CPR. In practice, manual CPR is not feasible since the CPR providers must stand in the X-ray projection pathway during ongoing intervention, thus obstructing the imaging and impeding the movement of the C-bow. Moreover, the cath lab patient table is not designed to withstand CPR when extended to its working/fluoroscopy position and it is therefore difficult to provide effective CPR during continued intervention.

Angiography and PCI on cardiac arrest patients during ongoing LUCAS

Larsen and co-workers have compiled the results from 13 out-of-hospital and in-hospital cardiac arrest patients who were transported to and treated in the cath lab during ongoing LUCAS compressions. Angiography and eventually PCI was possible in all cases during ongoing LUCAS chest compressions. There were no practical issues related to LUCAS application or ventilation. The mean LUCAS compression time was long; 105±60 minutes (range 45—240 minutes). The mean systolic and diastolic blood pressures obtained by LUCAS were 81±23 and 34±21 mmHg, respectively. Three patients survived the procedure, but for no longer than 72 hours. Manual CPR would have been almost impossible and could not have been extended for a prolonged period. LUCAS was considered well suited for use in the cath lab and ensured adequate systemic blood pressure in most patients without life-threatening injuries.

Pubmed link: Larsen et al; Resuscitation. 2007 Dec;75(3):454-9

Larsen AI, Hjornevik AS, Ellingsen CL, Nilsen DWT. ”Cardiac arrest with continuous mechanical chest compression during percutaneous coronary intervention. A report on the use of the LUCAS device.” Resuscitation. 2007; 75 (3): 454 -459

LUCAS can save patients with refractory cardiac arrest during coronary

This is an analysis from 2004-2007 of 28 patients who arrived alive to the cath lab and then required prolonged CPR/mechanical chest compression during the interventional cardiac procedure. 5/28 patients in the study were beyond any chance of survival due to the diagnosis of myocardial rupture. Eight patients were successfully treated with PCI, seven of whom were discharged alive. It is unlikely that any of these could have survived without the use of mechanical chest compressions in the cath lab since a continued procedure with maintained circulation was crucial to their survival.

Wagner H, Van der Pals, Olsson H R, Gotberg M, Harnek J, Olivecrona G. “Mechanical chest compression devices can save lives in the cath lab”. Resuscitation. 2008; 77S: S12, AS-031

One of the cases from Lund is reported in detail in the pdf below.

Olivecrona G, Bondesson P. “Mechanical Chest Compressions in a Patient with Left Main Closure During PCI.” tctmd.com, Case of the week, 24th of October 2006

Olivecrona Mechanical chest compressions_2006_tctmd.pdf

The same case was chosen as one of the most interesting cases at the international congress for interventional cardiologists; EuroPCR07.

LUCAS CPR and angiography of a heart that has arrested

This angiography shows a heart in cardiac arrest. After a short while LUCAS™ is started and the contrast is immediately circulated. LUCAS™ sustains the blood circulation of cardiac arrest patients in the cath lab and allows for simultaneous intervention to treat the cause of the arrest.

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Angiographic film, courtesy of Dr. G K Olivecrona, Lund University Hospital, Lund, Sweden

1) Larsen et al; Resuscitation. 2007 Dec;75(3):454-9. Cardiac arrest with continuous mechanical chest compression during percutaneous coronary intervention A report on the use of the LUCAS device
2) Grogaard et al; J Am Coll Cardiol; 2007 Sep 11;50(11):1093-4.Continuous mechanical chest compressions during cardiac arrest to facilitate restoration of coronary circulation with PCI.
3) Agostoni et al; Int J Cardiol. (2007) Feb 28. Successful percutaneous treatment of an intraprocedural left main stent thrombosis with the support of an automatic mechanical chest compression device
4) Olivecrona et al; tctmd.com Case of the week 24th of October (2006) Mechanical Chest Compressions in a Patient with Left Main Closure During PCI

There are different generations (i.e., versions) of the LUCAS Chest Compression System. The first generation was driven by compressed air, whereas the later generations are driven by battery. Although all LUCAS versions are similar in most respects and deliver chest compressions according to the AHA and ERC guidelines, they differ somewhat in mechanical design and usability. The differences need to be considered when extrapolating clinical and animal data from the different versions.

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