Lund University Cardiopulmonary Assist System Research Articles

Liver Hemorrhage Following Mechanical CPR With the Lund University Cardiopulmonary Assist System (LUCAS) Device: A Focused Case Report

Liver Hemorrhage Following Mechanical CPR With the Lund University Cardiopulmonary Assist System (LUCAS) Device: A Focused Case Report

Manual vs Mechanical Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest on a Ski Slope: A Pilot Study.

The quality of cardiopulmonary resuscitation (CPR) is critical in increasing the probability of survival with a good neurologic outcome after out-of-hospital cardiac arrest. In an austere environment with a potentially salvageable patient, bystanders or first responders may need to provide chest compressions for a prolonged duration or during physically challenging transportation scenarios. Consequently, they may be at risk of fatigue or injury, and chest compression quality may deteriorate. The study sought to assess whether or not access to and utilization of a mechanical compression device (Lund University Cardiopulmonary Assist System) was feasible and not inferior to manual compressions while extricating and transporting a patient from a ski slope. Variable 3-person ski patrol teams responded to a simulated patient with out-of-hospital cardiac arrest in a nonshockable rhythm. Using a mannequin and CPR quality monitor, performance during manual CPR was compared with that of a mechanical compression device. This is a prospective, crossover analysis of CPR quality during extrication from a ski slope. Across 8 total runs, chest compression fraction, which is the proportion of time without spontaneous circulation during which compressions occurred, and high-quality CPR, as measured by appropriate rate and depth, were compared between the 2 groups. Extrication times between the 2 groups were also measured. There was no difference in compression fraction between the manual (91.4%; 95% CI [86.8-96.1]) and mechanical arms (92.8%; 95% CI [88.8-96.8]) (P=0.67). There was an increase in the time performing high-quality CPR in the mechanical group (58.5%; 95% CI [45.8-71.2]) vs that in the manual group (25.6%; 95% CI [13.5-37.8]) (P<0.001). There was a statistically significant difference in the extrication times between the 2 groups, 7.6 ± 0.5 min in the manual group vs 8.6 ± 0.4 min in the mechanical group (P=0.014). Mechanical CPR devices are noninferior for use in ski areas during initial resuscitation and transportation. Compared with manual CPR, mechanical CPR would likely improve the fraction of time performing high-quality CPR.

LUCAS II Device for Cardiopulmonary Resuscitation in a Nonselective Out-of-Hospital Cardiac Arrest Population Leads to Worse 30-Day Survival Rate Than Manual Chest Compressions.

The LUCAS (Lund University Cardiopulmonary Assist System; Physio-Control Inc./Jolife AB, Lund, Sweden) was developed for automatic chest compressions during cardiopulmonary resuscitation (CPR). Evidence on the use of this device in out-of-hospital cardiac arrest (OHCA) suggests that it should not be used routinely because it has no superior effects. The aim of this study was to compare the effect of CPR for OHCA with and without LUCAS via a regional nonurban emergency medical service (EMS) physician-present prehospital medical system. We analyzed a prospective registry of all consecutive OHCA patients in four EMS stations. Two of them used a LUCAS device in all CPR, and the EMS crews in the other two stations used manual CPR. Individuals with contraindication to LUCAS or with EMS-witnessed arrest were excluded. Data from 278 patients were included in the analysis, 144 with LUCAS and 134 with manual CPR. There were more witnessed arrests in the LUCAS group (79.17% vs. 64.18%; p=0.0074) and patients in the LUCAS group were older (p = 0.03). We found no significant difference in return of spontaneous circulation (30.6% in non-LUCAS vs. 25% in LUCAS; p=0.35). In the LUCAS group, we observed significantly more conversions from nonshockable to shockable rhythm (20.7% vs. 10.10%; p=0.04). The 30-day survival rate was significantly lower in the LUCAS group (5.07% vs. 16.31% in the non-LUCAS group; p=0.044). At 180-day follow-up, we observed no significant difference (5.45% in non-LUCAS vs. 9.42% in LUCAS; p=0.25). Use of the LUCAS system decreased survival rate in OHCA patients. Significantly higher 30-day mortality was seen in LUCAS-treated patients.

Cardiac Arrest and The Use of Mechanical Compression Devices in Patients Presenting for Primary Percutaneous Coronary Intervention

Background: Cardiac arrest has been associated with poor outcomes in patients presenting for primary percutaneous coronary intervention (PPCI). Mechanical compression devices such as the Lund University Cardiopulmonary Assist System (LUCAS-3) aim to reduce ischaemic time during cardiopulmonary resuscitation. Methods: We conducted a retrospective review of consecutive patients with ST-elevation myocardial infarction or suspected severe myocardial ischaemia undergoing PPCI at a large tertiary institution between January 2017–December 2018. The study group comprised patients with an out-of-hospital cardiac arrest (OOHCA), in-hospital cardiac arrest (IHCA), or both. Demographic data, downtime (defined as the time from recognised arrest to return of spontaneous circulation (ROSC)), use of the LUCAS-3, and survival to discharge, were collected. Results: Of 630 patients, 80 (12.7%) were identified as either OOHCA, IHCA, or both; of whom 75 (93.4%) achieved ROSC prior to attempt at PPCI. 7 patients had an on-table IHCA during angiography without obtaining ROSC. 55 patients (68.8%) were discharged alive. Comparison of baseline demographics between survival to discharge and fatality: Age: 59.8 vs 65.7 years (p = 0.018), median downtime 4 vs 32 minutes (p < 0.001), gender was not significant (p = 0.32). ROSC was achieved in all vs 52% (p < 0.001) respectively. LUCAS-3 was used in 16 patients, of whom 3 were discharged alive and had achieved ROSC prior to attempt at PPCI. Conclusions: Younger age, shorter downtime, and ROSC predict survival to discharge in patients with OOHCA, IHCA, or both who present for PPCI. LUCAS-3 did not show utility in our cohort in the absence of ROSC prior to PPCI.

Successful Management of Severe Liver Laceration Secondary to Lund University Cardiopulmonary Assist System Cardiopulmonary Resuscitation Complicated by Systemic Heparin for Extracorporeal Membrane Oxygenation and Dual Antiplatelets After ST Elevation Myocardial Infarction

Successful Management of Severe Liver Laceration Secondary to Lund University Cardiopulmonary Assist System Cardiopulmonary Resuscitation Complicated by Systemic Heparin for Extracorporeal Membrane Oxygenation and Dual Antiplatelets After ST Elevation Myocardial Infarction

Mechanical CPR in a child: can one size fit all?

This case report describes the successful resuscitation of an 11-year-old boy who suffered out-of-hospital cardiac arrest (OHCA) using mechanical cardiopulmonary resuscitation (CPR) by adapting the Lund University Cardiopulmonary Assist System...

Forensic imaging findings by post-mortem computed tomography after manual versus mechanical chest compression

Abstract Objectives The aim of this study was to compare the injuries observed after cardiopulmonary resuscitation ( 1 CPR) by means of standard or assisted chest compression by the Lund University Cardiopulmonary Assist System ( 2 LUCAS™2) device visualized by post-mortem computed tomography ( 3 PMCT). Materials and methods A retrospective study was conducted that included 44 cases delivered to our institution following CPR before death. All bodies underwent PMCT. The case group was divided into two groups: one group that underwent manual and one group that underwent mechanical CPR with the LUCAS™2 device. The main traumatic findings associated with CPR were reported, and a statistical evaluation was performed. Results The LUCAS group comprised 24 cases, the manual group 20 cases. Rib fractures were the most frequent injury in both groups. A mean of 10.38 rib fractures per case was observed in the LUCAS group, and 10.40 fractures were observed in the manual group ( p =0.999). Subcutaneous pre-sternal hematomas were described in 15/24 patients in the LUCAS group and in 6/20 patients in the manual group. The frequency of sternal factures was similar in both groups. A few trauma injuries to internal organs (i.e., retrosternal, perihepatic, and retroperitoneal hematomas and lung contusion) were recorded in both groups. Conclusion PMCT is useful for evaluating injuries related to CPR. LUCAS™2-CPR has a greater association with subcutaneous pre-sternal hematomas than standard CPR. There is no further significant difference in the incidence of injuries between mechanical and manual chest compression. From a forensic point of view, it is important to identify CPR-related injuries.

Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS2): a forensic autopsy study.

The aim of our study was to compare traumatic injuries observed after cardiopulmonary resuscitation (CPR) by means of standard (manual) or assisted (mechanical) chest compression by Lund University Cardiopulmonary Assist System, 2nd generation (LUCAS2) device. A retrospective study was conducted including cases from 2011 to 2013, analysing consecutive autopsy reports in two groups of patients who underwent medicolegal autopsy after unsuccessful CPR. We focused on traumatic injuries from dermal to internal trauma, collecting data according to a standardised protocol. The study group was comprised of 26 cases, while 32 cases were included in the control group. Cardiopulmonary resuscitation performed by LUCAS2 was longer than manual CPR performed in control cases (study group: mean duration 51.5 min; controls 29.4 min; p = 0.004). Anterior chest lesions (from bruises to abrasions) were described in 18/26 patients in the LUCAS2 group and in 6/32 of the control group. A mean of 6.6 rib fractures per case was observed in the LUCAS2 group, but this was only 3.1 in the control group (p = 0.007). Rib fractures were less frequently observed in younger patients. The frequency of sternal factures was similar in both groups. A few trauma injuries to internal organs (mainly cardiac, pulmonary and hepatic bruises), and some petechiae (study 46%; control 41 %; p = 0.79) were recorded in both groups. LUCAS™2-CPR is associated with more rib fractures than standard CPR. Typical round concentric skin lesions were observed in cases of mechanical reanimation. No life-threatening injuries were reported. Petechiae were common findings.

Helicopter-based in-water resuscitation with chest compressions: a pilot study

BackgroundDrowning is a relevant worldwide cause of severe disability and death. The delay of ventilations and chest compressions is a crucial problem in drowning victims. Hence, a novel helicopter-based ALS...

Complications of mechanical chest compression devices

CaseA 77-year-old woman was found on the street, next to herbike. She appeared to be unconscious, suffering from headinjury and had no detectable pulse. Chest compressions wereinitiated bybystandersuntil theambulancearrived.Pulse-lesselectrical activity (PEA) was observed and a mechanicalchest compression device (LUCAS: Lund UniversityCardiopulmonary Assist System, Jolife, Sweden, Fig. 1)waspositioned to deliver chest compressions. Manual maskventilation was difficult to apply and several attempts wererequired for tracheal intubation. After two doses of 1 mg ofepinephrine return of spontaneous circulation (ROSC) wasestablished.Upon arrival at the hospital, she remainedhaemodynamically unstable and a swollen and firm abdomenwas observed. Chest radiography revealed massivesubdiapharmatic free air (Fig. 2). Emergent laparotomy wasperformed, which showed a few holes in the stomachindicating blowout injury. At that time, there was no injuryto the liver, spleen, or intestines. After performing a resectionof the gastric minor curvature, she became clinically stable.During the following days, however, progressive clinicaldeteriorationensuedduetointestinal ischaemiaandtwomorelaparotomies were performed. Because of ongoingdeterioration, further treatment was terminated after whichshe died.DiscussionMechanical chest compression devices (MCCDs) areincreasingly used during cardiopulmonary resuscitation(CPR) and they ensure continuous compressions of highquality, even during transportation [1]orduringproceduressuch as percutaneous interventions [2]. Experimental trialshaveshownimprovedorganperfusioncomparedwithmanualchest compressions in pigs, [3, 4] but a pilot study inhumans did not indicate improvement in early survival inout-of-hospital cardiac arrest [5]. Two larger, prospectiveclinical trials on outcome are ongoing: the LINCtrial (NCT00609778) and the PARAMEDIC trial(ISRCTN08233942) [6].Buschmann et al. described an association betweenmanual chest compressions and various injuries. Rib and

Intraoperative Use of an Automated Chest Compression Device

Intraoperative Use of an Automated Chest Compression Device

Thrombolysis associated with LUCAS (Lund University Cardiopulmonary Assist System) as treatment of valve thrombosis resulting in cardiac arrest

Thrombolysis associated with LUCAS (Lund University Cardiopulmonary Assist System) as treatment of valve thrombosis resulting in cardiac arrest

Mechanical Cardiopulmonary Resuscitation Device in an Accident and Emergency Department: A Case Report and Literature Review

We present a case of resuscitation of a 38-year-old lady with ventricular fibrillation using the Lund University Cardiopulmonary Assist System (LUCAS), a mechanical cardiopulmonary resuscitation (CPR) device. Return of spontaneous circulation was obtained after prolonged resuscitation but the patient eventually succumbed nine days after admission to the coronary care unit. The role of mechanical CPR devices in resuscitation in the accident and emergency department is discussed.

Ambient oxygen concentrations resulting from use of the Lund University Cardiopulmonary Assist System (LUCAS) device during simulated cardiopulmonary resuscitation

Supplementary oxygen is used routinely during cardiopulmonary resuscitation (CPR). High ambient oxygen levels from ventilation circuits have caused fatal fires and explosions. The Lund University Cardiopulmonary Assist System (LUCAS) device is driven by > 70 l min(-1) oxygen which is also likely to increase ambient oxygen concentrations and cause similar risk of fire and explosion. This study used simulated CPR with a LUCAS device to measure resulting ambient oxygen concentrations and assess safety of the device. Simulated manikin CPR using a LUCAS device was performed outdoors, inside an ambulance (ventilation off and ventilation on full power), and in a resuscitation bay. Ambient oxygen concentrations were measured over the apical and sternal defibrillation sites and midway between the two, at the head and 1m horizontally above the head. Recordings were made for 5 min when the LUCAS device was turned on and for a further 5 min when turned off. Ambient oxygen concentration increased quickly in all four scenarios. Peak oxygen levels over the chest were highest in the resuscitation bay (36.7%) and lowest in the ambulance with ventilation on full power (33.8%). Oxygen levels decreased to baseline within 5 min of turning off the LUCAS device. The use of oxygen to drive the LUCAS device results in a rapid increase in ambient oxygen concentration to levels likely to risk injury or death from fire. Ambulance services and hospitals using the device must be alerted to these dangers immediately.

Treatment of out-of-hospital cardiac arrest with LUCAS, a new device for automatic mechanical compression and active decompression resuscitation

Lund University Cardiopulmonary Assist System (LUCAS) is a new gas-driven CPR device providing automatic chest compression and active decompression. This is a report of the first 100 consecutive cases treated with LUCAS due to out-of-hospital cardiac arrest (58% asystole, 42% ventricular fibrillation (VF)). Safety aspects were also investigated and it was found that LUCAS can be used safely regarding noise levels and oxygen concentrations within the ambulance. A crash test (10 G) showed no displacement of the device from the manikin. Of the 71 patients with witnessed cardiac arrest, 39% received bystander CPR. In those 28 patients where LUCAS-CPR was initiated more than 15 min after the ambulance alarm and in the 29 unwitnessed cases, none survived for 30 days. Of the 43 witnessed cases treated with LUCAS within 15 min, 24 had VF and 15 (63%) of these cases achieved a stable return of spontaneous circulation (ROSC) and 6 (25%) of them survived with a good neurological recovery after 30 days; 5 (26%) of the 19 patients with asystole achieved ROSC and 1 (5%) survived for over 30 days. One patient where ROSC could not be achieved was transported with on-going LUCAS-CPR to the catheter laboratory and after PCI for an occluded LAD a stable ROSC occurred, but the patient never regained consciousness and died 15 days later. To conclude, establishment of an adequate cerebral circulation as quickly as possible after cardiac arrest is mandatory for a good outcome. In this report patients with a witnessed cardiac arrest receiving LUCAS-CPR within 15 min from the ambulance call had a 30-day survival of 25% in VF and 5% in asystole, but if the interval was more than 15 min, there were no 30-day survivors.

Electrical and mechanical aspects of left atrial activity.

<b>Background:</b> The Lund University Cardiopulmonary Assist System (LUCAS) is a gas-driven mechanical cardiopulmonary resuscitation device. If oxygen is used as the driving gas in a confined environment, there is a potential fire hazard. 24% oxygen is considered the threshold for increased risk. <b>Objective and methods:</b> Three trials were conducted using different cabin ventilation settings to determine the rise in oxygen concentration in an MD902 helicopter during use of the LUCAS. <b>Results:</b> The oxygen concentration rose rapidly with the aircraft at rest, but during flight, using realistic cabin ventilation settings and durations of use, the oxygen concentration failed to reach 24%. <b>Conclusion:</b> The LUCAS is safe for normal-duration flights in an MD902 helicopter. It is potentially unsafe in a static MD902 and, by extrapolation, in other static aircraft of similar or smaller size such as the EC135 or Bolkow 105.