Clinical paperA pilot study of mechanical chest compressions with the LUCAS™ device in cardiopulmonary resuscitation☆
Introduction
Several studies have demonstrated the need to perform cardiopulmonary resuscitation (CPR) with high quality chest compressions, in order to increase the chance of restoring spontaneous circulation 1, 2, 3, 4, 5, 6, 7, 8. Manual chest compressions, at best, result in a cardiac output of approximately 20–30% of normal, and their effectiveness is limited by the rescuers’ endurance 9, 10, 11, 12, 13. There is evidence of a significant amount of hands-off time during CPR [13], and it is difficult to maintain effective chest compressions during transport [14]. Furthermore, it has been postulated that after a long period of CPR the elastic recoil of the thoracic wall will diminish 15, 16, and this could impair the success of the resuscitation. The possibility of coronary intervention before return of spontaneous circulation (ROSC) [17] has extended the time for which CPR can be considered. All these considerations have led to a revival of the idea of a machine to aid rescuers in CPR.
In 2002 a device called LUCAS™ was introduced in Sweden; it was claimed to be quick to mount and easy to use, even during transport of patients with ongoing CPR [18]. One concern has been the possibility of harm caused by the device [19], but in an autopsy study of 85 patients no difference was found in the incidence of injuries with the LUCAS™ device compared to those with manual chest compressions [20]. The device has been evaluated in experimental cardiac arrest (CA) studies, where it has been shown to increase cortical cerebral blood flow and cardiac output 18, 21. In a small study, mechanical chest compressions with the LUCAS™ device did not improve the outcome, but the exclusion rate and time to apply the LUCAS™ device were substantial [22]. The LUCAS™ device clearly needs to be evaluated in a prospective study where it will be applied within a time frame in which improved outcome is possible. We conducted this pilot study to further evaluate the LUCAS™ device prior to a larger clinical trial.
We hypothesised that out-of-hospital cardiac arrest patients treated with mechanical chest compressions using the LUCAS™ device during CPR in a first-tier ambulance system would have improved short-term outcome compared to those treated with standard advanced cardiac life support.
Section snippets
Material and methods
The study was reviewed and approved by the human ethics committee in Uppsala, Sweden. The committee waived the need for informed consent. The pilot study was conducted within the fixed dates of February 1, 2005, to April 1, 2007, in out-of-hospital patients with sudden cardiac arrest. Patients were randomised to receive treatment with either manual chest compressions (manual group) or mechanical chest compressions with the LUCAS™ device (LUCAS group). Sealed randomisation letters were regularly
Results
During a period of 26 months, 149 patients were enrolled in the study. One patient was excluded due to the fact that the randomisation letter never was opened. After the exclusion, the LUCAS and the manual groups contained 75 and 73 patients respectively and there was no difference concerning demographic data, first recorded ECG rhythm, witnessing of cardiac arrest, or bystander CPR (Table 1).
The mean time from dispatch call to start of CPR was 8.3 min in the LUCAS group and 7.5 min in the manual
Discussion
In this pilot study there was no difference in early survival after out-of-hospital cardiac arrest between patients treated with manual chest compressions and those treated with mechanical chest compressions using the LUCAS™ device. One patient in the manual group that survived was treated with the LUCAS-device. None of the surviving patients in the LUCAS group did receive manual chest compressions only. Among the non-surviving patients, there were 5 patients in the LUCAS group that did receive
Conclusion
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 LUCAS™ device compared to CPR with manual chest compressions. We believe that checking for protocol execution quality, training, and re-training could be important when conducting studies in the future.
Conflict of interest statement
The authors hereby certify that we have all seen and approved the paper and that the work has not been, and will not be, published elsewhere. David Smekal, Jakob Johansson, and Tibor Huzevka declare no conflict of interest. Sten Rubertsson has received a consulting fee from Jolife AB, Sweden.
Acknowledgements
The authors wish to express their gratitude to the EMS personnel in Uppsala and Gävle, Sweden. We also wish to thank Lars Berglund and Karin Jensevik, biostatisticians at the Uppsala Clinical Research Centre (UCR) for help with evaluation of the statistics. This study has been supported by an institutional grant from Uppsala University.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.01.032.