Abstract 100: Mechanical Devices Are More Effective than Manual Compressions Regarding Resuscitation Concomitant with Emergency Percutaneous Coronary Intervention in Cardiac Arrest

Abstract

Introduction: Cardiac arrest during procedures in the Cath Lab is excessively harmful, as manual chest compressions prevents the continuity of coronary angiography and coronary angioplasty and require the assistance of trained staff in cardiopulmonary resuscitation (CPR) quickly and accurately. AutoPulse® is a mechanical CPR device that consists of mechanical pneumatic band attached to a board that involves the patient’s chest and allows effective and continuous pneumatic compressions, allowing mechanical CPR simultaneously to coronary angiography and angioplasty. Hypothesis: We assessed the hypothesis that mechanical CPR may be feasible during percutaneous coronary interventions and more effective than manual CPR by the analysis of intra-coronary pressure curves. Methods: The device was used in 6 consecutive cases of cardiac arrests (ventricular fibrillation refractory to attempts of defibrillation and standard treatment) in the Cath Lab, allowing continuity of percutaneous coronary intervention concomitant with CPR. Intra-coronary curves were measured initially during manual chest compressions (manual CPR) and later, after the correct installation of AutoPulse® during mechanical compressions with this device (mechanical CPR). Results: It was possible to complete coronary angiography with the device attached to the patient in all cases, and it was also possible to complete coronary angioplasty during mechanical CPR. In all cases, mechanical CPR provided uninterrupted chest compressions more effectively and always stable in stead of manual compressions. Although a mean blood pressure of 40mmHg in both methods, mechanical CPR was able to maintain this pressure for a long time, but manual CPR had an important reduction in mean blood pressure after two minutes of CPR in all cases. Conclusions: In conclusion, percutaneous coronary interventions are feasible concurrent with mechanical CPR using AutoPulse® in patients suffering cardiac arrest in the Cath Lab. The device provided uninterrupted chest compressions more effective than manual compressions, as well as allowed the freedom of the physicians to attempt other functions, different from CPR, during the procedures.