How To Use A Lucas Device

HSR Proc Intensive Care Cardiovasc Anesth. 2011; iii(3): 203–205.

Use of the LUCAS mechanical chest compression device for percutaneous coronary intervention during cardiac abort: is it really a game changer?

G Biondi-Zoccai

¹Sectionalization of Cardiology, University of Modena and Reggio Emilia, Modena, Italy

K Landoni

²Section of Anesthesia and Intensive Intendance, Università Vita-Salute San Raffaele, Milan, Italy

A Zangrillo

ⁱⁱDepartment of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italian republic

P Agostoni

³Partitioning of Cardiology, Utrecht University Medical Center, Utrecht, The netherlands

Yard Sangiorgi

⁴Division of Cardiology, University of Tor Vergata, Rome, Italy

M One thousand Modena

^anePartitioning of Cardiology, Academy of Modena and Reggio Emilia, Modena, Italy

Abstract

Cardiopulmonary support including airtight chest pinch is a mainstay in the management of cardiac arrest. However, traditional ways (i.e. manual) breast compression may exist logistically challenging, peculiarly in patients requiring emergent invasive procedures such as percutaneous coronary intervention for cardiac arrest due to acute myocardial infarction. The LUCAS mechanical chest pinch device provides external and automatic airtight chest compression, thus enabling even circuitous invasive procedures without interrupting cardiopulmonary support. Withal, no randomized trial has proved to date its benefit in comparison to standard manual chest compression, and to date only observational studies and consensus stance support its clinical utilise.

Keywords: cardiac arrest, chest compression, LUCAS, percutaneous coronary intervention, PTCA, resuscitation

Cardiac arrest has a dire prognosis, with an average of only five% of patients being discharged alive without neurologic problems afterwards an out-of-hospital cardiac arrest [i].

Despite improvements in medical therapy and other devices modifying ventilatory support [2,3] cardiopulmonary support based specially on closed chest pinch is pivotal to maximize survival chances. All the same, manual chest compression is energy consuming and operator-intensive.

Moreover, it cannot exist performed successfully for a prolonged period of fourth dimension by any private healthcare provider nor in logistically challenging settings (e.g. helicopters). Manual breast pinch appears peculiarly challenging for patients in cardiac arrest who also require an emergent invasive procedure, such as primary percutaneous coronary intervention (PCI).

The LUCAS device (LUCAS ii, Jolife, Lund, Sweden) is a mechanical chest compression-decompression system which enabled automated and continuous closed breast compression, without unduly limiting other invasive procedures such as PCI [4,5,6,7,viii,ix].

It is unclear however whether the LUCAS device tin actually affect on the patient prognosis besides enabling uninterrupted PCI during a prolonged cardiac arrest, as exemplified by a contempo instance nosotros accept faced.

A forty-year-old gentleman with long-continuing type 1 diabetes mellitus was admitted to a spoke care center for suspected acute myocardial infarction, based on typical breast pain and lengthened non-ST-meridian myocardial infarction.

Shortly after access to the emergency room, the patient adult cardiac arrest due to ventricular fibrillation: He was successfully defibrillated merely then developed pulseless electrical activeness (PEA) despite several boluses of adrenaline. After tracheal intubation and mechanical ventilation, and while still nether continuous transmission breast compression, he was transferred to our hub care center for farther management. At arrival in our emergency section, systemic thrombolysis was attempted.

Given its lack of efficacy and the persistence of cardiac arrest due to (PEA), the LUCAS device was positioned and activated. The patient was thus transported to the cardiac catheterization laboratory, where selective coronary angiography was performed during continuous mechanical chest compression. A thrombotic subocclusion of the left main coronary stem was demonstrated, together with chronic full occlusions of the distal left anterior descending and distal right coronary artery (Figure one).

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Coronary angiography and stenting during continuous chest compression by means of the LUCAS device in a 40-year-old patient with cardiac arrest. Angiography showed a thrombotic subocclusion of the left main coronary stalk (panel A; pointer showing the subocclusive stenosis).

Afterwards pre-dilation with a 2.5x20 mm semi-compliant airship at 12 atmospheres at the left main-left circumflex level (panel B), a iii.5x25 mm bare-metallic stent was implanted upward to 20 atmospheres at the left main-left inductive descending level (console C), with a satisfactory result in terms of rest stenosis (panel D).

Despite this and continuous cardiopulmonary support, the patient never achieved a return of spontaneous circulation and was alleged dead 30 minutes afterwards the end of the revascularization process.

Thus, left chief stenting was performed by ways of PCI and three.5x25 mm bare-metallic stent implantation (Skylor, Invatec, Roncadelle, Italy) dilated at up to 20 atmospheres, achieving a satisfactory final result in terms of residual stenosis.

Despite this, no render of spontaneous circulation was possible, and the resuscitation efforts were interrupted thirty minutes after the end of the procedure. The following day, a mail service-mortem confirmed the astute myocardial infarction every bit the cause of death and the chronic occlusion of the distal left inductive descending and distal correct coronary artery, besides as showing a practiced patency of the implanted stent.

Despite the promising features of the LUCAS device, the just bachelor randomized trial on this topic, including 149 patients with out-of-hospital cardiac arrest, appears in understanding with our case study [x]. Indeed, in this written report Smekal et al did not show a statistically or clinically pregnant benefit from the use of the device (six of those treated with the LUCAS organisation discharged alive versus vii of those treated with manual pinch, p=0.8) [10].

Like doubtfulness stems from a negative prior study on the Autopulse Resuscitation System (Zoll, Chelmsford, MA, USA) [11], and an inconclusive recent Cochrane Collaboration systematic review including 4 trials and 868 patients [12]. Whereas a combined use of LUCAS and extra-corporeal membrane oxygenation (ECMO) systems would take been appealing in our case and is nether investigation, its purported benefits remain largely speculative and require further scientific proof.

Thus, awaiting the results of the upcoming 4000-patient Prehospital Randomised Cess of a Mechanical compression Device In Cardiac arrest (PaRAMeDIC) trial [13], we believe that the LUCAS device should all-time exist reserved to patients with cardiac abort without an ominous prognosis per se.

Footnotes

Source of Back up Nil.

Disharmonize of interest Dr. Biondi-Zoccai has consulted, lectured and received career grant support from Medtronic.

Cite as: Biondi-Zoccai G, Landoni G, Zangrillo A, Agostoni P, Sangiorgi 1000, Modena MG.. Apply of the LUCAS mechanical chest pinch device for percutaneous coronary intervention during cardiac arrest: is it actually a game changer? HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2011; 3(iii): 203-205

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