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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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Abstract LUCAS is a new gas-driven CPR device providing automatic chest compression and active decompression. In an artificial thorax model, superior pressure and flow were obtained with LUCAS compared with manual CPR. In a randomized study on pigs with induced ventricular fibrillation significantly higher cardiac output, carotid artery blood flow, end-tidal CO2, intrathoracic decompression-phase aortic- and coronary perfusion pressures were obtained with LUCAS-CPR (83% ROSC) compared to manual CPR (0% ROSC). In normothermic fibrillating pigs, the ROSC rate was 100% after 15 min and 38% after 60 min of LUCAS-CPR (no drug treatment). The ROSC rate increased to 75% if surface cooling to 34 8C was applied during the first 30 min of the 1-h resuscitation period. Experience with the first 20 patients has shown that LUCAS is light (6.5 kg), easy to handle, quick to apply (10 Á/20 s), maintains a correct position, and works optimally during transport both on stretchers and in ambulances. In one hospital patient with a witnessed asystole where manual CPR failed, LUCAS-CPR achieved ROSC within 3 min. One year later the patient’s mental capacity was fully intact. To conclude, LUCAS-CPR gives significantly better circulation during ventricular fibrillation than manual CPR.

# 2002 Elsevier Science Ireland Ltd. All rights reserved.

Keywords: Active compression Á/decompression; Cardiopulmonary resuscitation (CPR); Coronary perfusion pressure; End-tidal carbon dioxide;

Hypothermia; Return of spontaneous circulation (ROSC) Resumo

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Fig. 1. LUCAS is designed to fit on stretchers and to be easy to operate while walking and within ambulances. Defibrillator pads illustrate that defibrillation may be done under on-going compression Á/decompression.

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Fig. 2. LUCAS in place on a 23 kg pig. Due to the narrow upper thorax in pigs of this size, the silicon rubber suction cup does not fit snugly to the chest, and active decompression cannot be adequately tested.

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Fig. 5. Transverse section of a 23 kg pig just distal to processus xiphoideus. The heart ventricles are not compressed directly between the sternum and the spine during chest compressions due to the central position of the ventricles within the thoracic cavity. The anteroposterior diameter in this pig was 19.5 cm. Normal ventilated lungs (upper left), atelectatic lungs after disconnection from the ventilator (upper right), lungs extirpated (lower left), and manual forceful compression without direct compression of the ventricles between sternum and the spine (lower right).

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Fig. 6. Typical pressure-flow curves obtained by external compressions on the artificial thorax model. The left panel shows the data obtained when the male rescuer (75 kg body weight) did manual compressions with the force he had been trained to use on an adult patient (these values were defined as 100%). The middle panel shows when the same rescuer performed maximal forceful compressions. The right panel shows LUCAS-compressions.

The gas supply was breathing oxygen from a wall outlet (4 bar).

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Fig. 10. The pressure- and carotid flow curves in pigs with ROSC vs.

pigs without ROSC (Group II). Data shown as mean9/S.E.M., n0/8 in each group. VF0/induction of ventricular fibrillation. Def 0/ defibrillation.

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Fig. 14. LUCAS-CPR during 1 h of ventricular fibrillation (VF) with surface cooling during the first half hour. Temperature, systolic, mean Fig. 15. LUCAS-CPR during 1 h of ventricular fibrillation (VF) in and diastolic (SAP, MAP, DAP) intrathoracic aortic pressure, hypothermia. Temperature, systolic, mean and diastolic (SAP, MAP, coronary perfusion pressure, and right carotid arterial blood flow are DAP) intrathoracic aortic pressure, coronary perfusion pressure, and shown as mean9/S.E.M. n 0/8 (n0/6 after defibrillation (Def)). right carotid arterial blood flow are shown as mean9/S.E.M. n0/8 (n0/6 after defibrillation (Def)).

4. Discussion

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All baseline values were obtained at normothermia. All blood gas values were obtained with FiO2 0 1.0; the blood gas apparatus was adjusted to measure at the same temperature as the pig and with the pig mode.

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Abstract Outcome after prehospital defibrillation remains dire. The aim of the present study was to elucidate the pathophysiology of cardiac arrest and to suggest ways to improve outcome. Ventricular fibrillation (VF) was induced in air-ventilated pigs, after which ventilation was withdrawn. After 6.5 min of VF, ventilation with 100% oxygen was initiated. In six pigs (group I), defibrillation was the only treatment carried out. In another six pigs (group II), mechanical chest compression Á/decompression CPR (mCPR) was carried out for 3.5 min followed by a 40-s hands-off period before defibrillation. If unsuccessful, mCPR was resumed for a further 30 s before a second or a third, 40-s delayed, shock was given. In a final six pigs (group III) mCPR was applied for 3.5 min after which up to three shocks (if needed) were given during on-going mCPR. Return of spontaneous circulation (ROSC) occurred in none of the pigs in group I (0%), in 1 of six pigs in group II (17%) and in five of six pigs in group III (83%). During the first 3 min of VF arterial blood was transported to the venous circulation, with the consequence that the left ventricle emptied and the right ventricle became greatly distended. It took 2 min of mCPR to establish an adequate coronary perfusion pressure, which was lost when the mCPR was interrupted. During 30 s of mCPR coronary perfusion pressure was negative, but a carotid flow of about 25% of basal value was obtained. In this pig model, VF caused venous congestion, an empty left heart, and a greatly distended right heart within 3 min. Adequate heart massage before and during defibrillation greatly improved the likelihood of return of spontaneous circulation (ROSC).

# 2003 Elsevier Ireland Ltd. All rights reserved.

Keywords: Active compression Á/decompression; Non-interrupted CPR; CPR before defibrillation; Coronary perfusion pressure; Return of spontaneous circulation; LUCAS Resumo

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mCPR was given with LUCAS, a gas-driven device 2.6. Video film of the fibrillating heart providing automatic chest compression, and active ‘physiological? decompression. This is achieved by a Median sternotomy was performed in three additional rubber vacuum ring that brings a softened, flat, non- animals and the heart visualized by opening up the recoiling thorax back to its normal position during each pericardium. A video camera was fixed to a support so decompression phase. Defibrillation can be safely given that the heart could be filmed before induction of VF during on-going mCPR with this device. A detailed and during 6.5 min of VF. Defibrillation with 30 J was description of LUCAS has been given elsewhere [4]. attempted after the 6.5 min by means of paddles held 252 S. Steen et al. / Resuscitation 58 (2003) 249 Á/258 Fig. 1. The design of the experiments. The number of pigs with ROSC is indicated within the ROSC rectangle. D, defibrillation; VF, ventricular fibrillation; CPR, cardiopulmonary resuscitation.

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Fig. 2. Intrathoracic aortic pressure, pressure in the right atrium and computed coronary perfusion pressure are shown during 6.5 min of ventricular fibrillation followed by 3.5 min of mechanical chest compressions. Systolic, diastolic and mean pressure are shown to the left (base), and compression, decompression and mean pressure to the right (during CPR). The curves represent the mean values from 12 pigs. For the sake of clarity, the standard error of the mean is not shown in all curves.

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Fig. 3. The blood flow in the left internal carotide artery during 6.5 min of ventricular fibrillation followed by 3.5 min of mechanical chest compressions. The mean value9/S.E.M. is shown from 12 pigs.

254 S. Steen et al. / Resuscitation 58 (2003) 249 Á/258 Fig. 4. Pressure recordings of the first 10 min of ventricular fibrillation in one pig in which intrapericardial pressure was also registered.

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Fig. 6. Intrathoracic aortic compression pressure during 3.5 min of mechanical compressions followed by defibrillation with (II) and without (III) interrupting the chest compressions. Mean value9/S.E.M., n 0/5 in each group.

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Fig. 7. Coronary perfusion pressure during 3.5 min of mechanical compressions and during defibrillation attempts with (II) and without (III) interrupting the chest compressions. Mean value9/S.E.M., n 0/5 in each group.

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