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«LUCAS - Lund University Cardiopulmonary Assist System Liao, Qiuming Published: 01/01/2011 Link to publication Citation for published version (APA): ...»

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Injuries during chest compressions It is difficult to give manual compressions consistently, many compressions are either too shallow or too deep. People are trained to give correct chest compressions on mannequins which do not get rib fractures, i.e., what is registered as adequate forceful compressions in the beginning will not take into consideration the human condition that for each rib broken, less and less force will be needed to compress the chest 5 cm (16-18). If you use the same force as needed in the beginning to compress a human thorax 5 cm, also after several ribs have been broken, then the compressions will be too deep, with the risk of creating severe injuries. This was the case with the CardioPump, in which a scale indicated the force you should use in each compression, and this force was constant throughout the CPR period, regardless of the number of broken ribs, and regardless of the flattening of the thorax. Baubin demonstrated in studies on human corpses, that the CardioPump fractured the sternum in 9 out of 17 women and in 2 out of 20 men after 1 minute of CardioPump CPR (17). The female sternum is usually thinner and broader than the male sternum (30), and thus prone to greater fragility during chest compressions.

If manual CPR has been given before the application of LUCAS, it is important to judge if the thorax is already flattened due to multiple bilateral rib fractures. If LUCAS is applied too tight on an initially flattened thorax of a normal sized or on a small patient, the compression depth of 5 cm might diminish the antero-posteroir diameter too much with the risk of causing visceral injuries.

Multiple rib fractures will diminish the elastic recoil of the thorax after each compression. The elastic recoil of an intact thorax reduces the right atrial pressure and thereby will increase the venous return. Active decompression will lower the right atrial pressure in each decompression phase, and thereby increase both coronary perfusion pressure and venous return (Fig 22).

In the manual CPR group in paper III, one pig suffered a serious liver injury. It is important to consider that one too deep compression can cause such an injury. One of the disadvantages with manual CPR is the difficulty in controlling the depth of each compression. It was not surprising that LUCAS-CPR gave significantly fewer rib fractures than manual CPR, since the compression depth with LUCAS never can be more than 5 cm.

In clinical papers studying injuries after chest compressions with LUCAS, manual CPR was given before the application of LUCAS and therefore the injuries reported could have been caused before LUCAS was applied. A prospective human study comparing manual and LUCAS-CPR showed no increased rate of injuries in the LUCAS-CPR group (31). A study (32) on 106 pigs showed fewer injuries with LUCAS-CPR (n=53) compared to manual CPR (n=53). Autopsy was done on all animals. Sternal fractures were identified in 18 animals in the manual group and only two in the LUCAS group (p=0.003). Rib fractures were present in 16 pigs in the manual group and only four pigs in the LUCAS group (p=0.001).

Nine animals in the manual group and two in the LUCAS group had liver hematomas (p=0.026), and eight animals had spleen hematomas in the manual group, whereas no such injury was identified in the LUCAS group (p=0.003) (32).

Since the first scientific paper published on LUCAS (I) in 2002, several studies and reports have shown the efficacy of LUCAS-CPR (II, III, 33-65).

Conclusion

1. LUCAS-CPR is significantly more effective than manual CPR regarding coronary perfusion pressure and return of spontaneous circulation in different porcine models with ventricular fibrillation.

2. LUCAS-CPR combined with surface cooling to 34°C is superior to normothermic LUCAS-CPR during one hour resuscitation of pigs with ventricular fibrillation.

3. Chest compressions before defibrillation and defibrillation during ongoing chest compressions increase return of spontaneous circulation in a porcine model with prolonged ventricular fibrillation.

4. LUCAS-CPR causes significantly fewer rib fractures during 20 minutes of CPR compared to manual CPR in pigs.

Acknowledgements                        my coworkers. In particular, Audrius Paskevicius, Leif Pierre and Britta KronAll            borg for their skilled support on computers and medical deices.





        References

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