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Safety with Mechanical Chest Compressions in CPR: Clinical studies with the LUCAS™ device
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.ORCID iD: 0000-0002-3563-6450
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chest compressions in cardiopulmonary resuscitation are of utmost importance although not without a risk. Many injuries are described but the incidence of these is hard to define due to methodological differences. It is strenuous to perform chest compressions and therefore mechanical chest compressions have been looked upon with interest. This thesis presents new insights on the panorama and incidence of injuries in modern CPR and a comparison of safety and efficacy between manual chest compressions and mechanical chest compressions with the LUCAS™ device.

We also evaluated if computed tomography could be an aid in the detection of these injuries.

Two pilot trials were conducted and one presented no difference in early survival with 26% and 31% having return of spontaneous circulation when comparing manual chest compressions with the LUCAS device in out-of-hospital cardiac arrest. The other revealed no difference in autopsy-detected injuries. A third multicentre autopsy trial revealed that in patients treated with manual chest compressions 78.3% had at least one injury and 63.9% had at least one rib fracture. The corresponding numbers for patients treated with the LUCAS device was 92.8% (p = 0.002) and 77.7% (p=0.022). Sternal fractures occurred in 54.2% and in 58.3% of the cases treated with manual chest compressions and the LUCAS device respectively (p = 0.556). The median number of rib fractures was 7 in the group receiving manual chest compressions and 6 in the group receiving chest compressions with the LUCAS device. In 31 cases a computed tomography was conducted prior to autopsy and we found a very strong correlation in the discrimination of patients with or without rib fractures (kappa=0.83). Mean difference between the two methods in detecting rib fractures was 0.16. The detection of other injuries did not have a strong correlation. In conclusion there is no difference in early survival between the two methods and mechanical chest compressions adds 14-15% more patients with rib fractures but the amount of rib fractures, sternal fractures and other injuries is equal. CT can aid but not replace autopsies in the detection of these injuries.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 69 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 922
Keyword [en]
Cardiac arrest, Cardiopulmonary resuscitation, Mechanical chest compressions, Active compression-decompression, Injury, Autopsy, LUCAS
National Category
Other Clinical Medicine
Research subject
Medicine
Identifiers
URN: urn:nbn:se:uu:diva-204069ISBN: 978-91-554-8716-4 (print)OAI: oai:DiVA.org:uu-204069DiVA: diva2:639365
Public defence
2013-09-27, Ebba Enghoffsalen, Ingång 50 bv., Akademiska Sjukhuset, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2013-09-03 Created: 2013-07-21 Last updated: 2014-01-07
List of papers
1. No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS device--a pilot study
Open this publication in new window or tab >>No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS device--a pilot study
2009 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, no 10, 1104-1107 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To compare the variety and incidence of internal injuries after manual and mechanical chest compressions during CPR. METHODS: In a prospective pilot study conducted in two Swedish cities, 85 patients underwent autopsy after unsuccessful resuscitation attempts with manual or mechanical chest compressions, the latter with the LUCAS device. Autopsy was performed and the results were evaluated according to a specified protocol. RESULTS: No injuries were found in 26/47 patients in the manual group and in 16/38 patients in the LUCAS group (p=0.28). Sternal fracture was present in 10/47 in the manual group and 11/38 in the LUCAS group (p=0.46), and there were multiple rib fractures (> or =3 fractures) in 13/47 in the manual group and in 17/38 in the LUCAS group (p=0.12). Bleeding in the ventral mediastinum was noted in 2/47 and 3/38 in the manual and LUCAS groups respectively (p=0.65), retrosternal bleeding in 1/47 and 3/38 (p=0.32), epicardial bleeding in 1/47 and 4/38 (p=0.17), and haemopericardium in 4/47 and 3/38 (p=1.0) respectively. One patient in the LUCAS group had a small rift in the liver and one patient in the manual group had a rift in the spleen. These injuries were not considered to have contributed to the patient's death. CONCLUSION: Mechanical chest compressions with the LUCAS device appear to be associated with the same variety and incidence of injuries as manual chest compressions.

Keyword
Cardiac arrest, Injury, Active compression-decompression (ACD), Cardiopulmonary resuscitation (CPR), LUCAS, Autopsy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-113248 (URN)10.1016/j.resuscitation.2009.06.010 (DOI)000271336400005 ()19595496 (PubMedID)
Available from: 2010-01-26 Created: 2010-01-26 Last updated: 2017-12-12Bibliographically approved
2. A pilot study of mechanical chest compressions with the LUCAS (TM) device in cardiopulmonary resuscitation
Open this publication in new window or tab >>A pilot study of mechanical chest compressions with the LUCAS (TM) device in cardiopulmonary resuscitation
2011 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 82, no 6, 702-706 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The LUCASTM device has been shown to improve organ perfusion during cardiac arrest in experimental studies. In this pilot study the aim was to compare short-term survival between cardiopulmonary resuscitation (CPR) performed with mechanical chest compressions using the LUCASTM device and CPR performed with manual chest compressions. The intention was to use the results for power calculation in a larger randomised multicentre trial. Methods: In a prospective pilot study, from February 1, 2005, to April 1, 2007, 149 patients with out-of hospital cardiac arrest in two Swedish cities were randomised to mechanical chest compressions or standard CPR with manual chest compressions. Results: After exclusion, the LUCAS and the manual groups contained 75 and 73 patients, respectively. In the LUCAS and manual groups, spontaneous circulation with a palpable pulse returned in 30 and 23 patients (p = 0.30), spontaneous circulation with blood pressure above 80/50 mmHg remained for at least 5 min in 23 and 19 patients (p = 0.59), the number of patients hospitalised alive >4 h were 18 and 15 (p = 0.69), and the number discharged, alive 6 and 7 (p = 0.78), respectively. Conclusions: In this pilot study of out-of-hospital cardiac arrest patients we found no difference in early survival between CPR performed with mechanical chest compression with the LUCASTM device and CPR with manual chest compressions. Data have been used for power calculation in a forthcoming multicentre trial.

Keyword
Cardiac arrest, Active compression-decompression (ACD), Cardiopulmonary resuscitation (CPR), Out-of-hospital CPR, Mechanical devices, Survival, Device, LUCAS
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-155215 (URN)10.1016/j.resuscitation.2011.01.032 (DOI)000291341500015 ()
Available from: 2011-06-21 Created: 2011-06-20 Last updated: 2017-12-11Bibliographically approved
3. Comparison of computed tomography and autopsy in detection of injuries after unsuccessful cardiopulmonary resuscitation
Open this publication in new window or tab >>Comparison of computed tomography and autopsy in detection of injuries after unsuccessful cardiopulmonary resuscitation
2013 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 84, no 3, 357-360 p.Article in journal (Refereed) Published
Abstract [en]

AIM:

Computed tomography (CT) has been suggested as an aid or even a replacement for autopsy. The aim of this trial was to study the conformity of the two methods in finding injuries in non-surviving patients after unsuccessful cardiopulmonary resuscitation.

METHODS:

In this prospective study, 31 patients were submitted to a CT prior to autopsy after unsuccessful resuscitation attempts. Pathological findings were noted by both the radiologist and the pathologists in a specified protocol. The pathologists and radiologist were blinded from each other's results.

RESULTS:

CT and autopsy revealed rib fractures in 22 and 24 patients respectively (kappa=0.83). In 8 patients, CT revealed more rib fractures than autopsy; and in 12 patients, autopsy revealed more rib fractures than CT. In 7 patients, neither method showed any rib fractures. The mean difference between the two methods in detecting rib fractures was 0.16 (S.D.: ±3.174, limits of agreement: -6.19 to 6.51). The kappa value for sternal fractures was 0.49. A total of 260 pathological findings were noted by CT and 244 by autopsy. The average patient showed a median of 9 injuries (every fracture counted as one injury), independent of the method used in detecting the injuries.

CONCLUSIONS:

There was a strong concordance between the two methods in finding rib fractures but not sternal fractures and these results support the concept of CT as a valuable complement to autopsy in detecting rib fractures after unsuccessful cardiopulmonary resuscitation but not as a replacement. Other injuries did not show the same concordance.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-182251 (URN)10.1016/j.resuscitation.2012.06.023 (DOI)000318164200025 ()22776515 (PubMedID)
Available from: 2012-10-08 Created: 2012-10-08 Last updated: 2017-12-07Bibliographically approved
4. CPR related injuries after manual or mechanical chest compressions with the LUCAS™ device: A multicentre study in victims after unsuccessful resuscitation
Open this publication in new window or tab >>CPR related injuries after manual or mechanical chest compressions with the LUCAS™ device: A multicentre study in victims after unsuccessful resuscitation
Show others...
2014 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 12, 1708-1712 p.Article in journal (Refereed) Published
Abstract [en]

AIM: The reported incidence of injuries due to cardiopulmonary resuscitation using manual chest compressions (manual CPR) varies greatly. Our aim was to elucidate the incidence of CPR-related injuries by manual chest compressions compared to mechanical chest compressions with the LUCAS device (mechanical CPR) in non-survivors after out-of-hospital cardiac arrest.METHODS: In this prospective multicentre trial, including 222 patients (83 manual CPR/139 mechanical CPR), autopsies were conducted after unsuccessful CPR and the results were evaluated according to a specified protocol.RESULTS: Among the patients included, 75.9% in the manual CPR group and 91.4% in the mechanical CPR group (p=0.002) displayed CPR-related injuries. Sternal fractures were present in 54.2% of the patients in the manual CPR group and in 58.3% in the mechanical CPR group (p=0.56). Of the patients in the manual CPR group, there were 64.6% with at least one rib fracture versus 78.8% in the mechanical CPR group (p=0.02). The median number of rib fractures among patients with rib fractures was 7 in the manual CPR group and 6 in the mechanical CPR group. No CPR-related injury was considered to be the cause of death.CONCLUSION: In patients with unsuccessful CPR after out-of-hospital cardiac arrest, rib fractures were more frequent after mechanical CPR but there was no difference in the incidence of sternal fractures. No injury was deemed fatal by the pathologist.

Keyword
Sudden cardiac arrest, Cardiopulmonary resuscitation, Injury, Complications, Autopsy, Device, LUCAS
National Category
Other Clinical Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:uu:diva-204638 (URN)10.1016/j.resuscitation.2014.09.017 (DOI)000346603700019 ()25277343 (PubMedID)
Available from: 2013-08-07 Created: 2013-08-07 Last updated: 2017-12-06Bibliographically approved

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