Abstract P71: The Decisive Role of Effective Continuous Chest Compression for In-Hospital Cardiopulmonary Resuscitation of Patients with Pulseless Electrical Activity
The quality of cardiopulmonary resuscitation of in-hospital cardiac arrest is inconsistent and often does not meet published guideline recommendations, even when performed by well-trained hospital staff. Furthermore, of patients with cardiac arrest, those with pulseless electrical activity (PEA) have the worst outcome. Especially in these patients guideline-conform effective chest compression may be the key strategy to improve survival. We therefore investigated, whether a novel mechanical device (LUCAS-CPR) may ensure compression according to the guidelines and without interruption during transport, diagnostic procedures and in the catheter laboratory, and thus improve rates of return of spontaneous circulation (ROSC) and 14-day-survival.
Methods and Results: We evaluated mechanical chest compression (LUCAS-CPR) during in-hospital resuscitation of 14 patients with PEA (fulminant pulmonary embolism (PE) n=9; thrombotic main-stem occlusion; n=3; severe hyperkalemia; n=1; after ICD-testing during CRT-ICD-implatation; n=1) in a university hospital setting. During or directly after CPR, 12 patients underwent coronary angiography/pulmonary angiography. In all patients ROSC was achieved. Two patients died within the first hour, another two patients died within 24 hours after CPR. A total of 10 patients survived and were discharged from hospital without significant neurological deficits. Interestingly, three of these patients with PE did not undergo thrombolytic therapy due to major contraindications. CT-angiographic findings in those patients with PE consistently showed a fragmentation of the thrombus, suggestive of a mechanical thrombus separation as an additional effect of effective chest compression. None of the patients exhibited any life-threatening device-related complications.
Conclusion: Guideline-conform chest compression with an automatic device significantly improves outcome after in-hospital-resuscitation of PEA (ROSC 100%; survival rate after 14 days 71%). Especially those patients with PE and contraindications for thrombolytic therapy seem to benefit most from effective continuous chest compression, probably due to thrombus fragmentation and increased pulmonary artery flow.