Prolonged closed cardiac massage using LUCAS device in out-of-hospital cardiac arrest with prolonged transport time

Edouard Matevossian¹, Dietrich Doll⁴, Jakob Säckl¹, Inga Sinicina⁵, Jürgen Schneider², Gerhard Simon³, Norbert Hüser¹

¹Department of Surgery, ²Department of Anesthesiology and Intensive-Care Medicine; ³Department of Radiology, Technische Universität of Munich, Germany; ⁴Department of Visceral, Vascular and Thoracic Surgery, Philips University of Marburg, Marburg, Germany; ⁵Institute of Clinical Forensic Medicine, Ludwig-Maximilian University of Munich, Munich, Germany

Abstract: Saving more human lives through more effective reanimation measures is the goal of the new international guidelines on cardiopulmonary resuscitation as the decisive aspect for survival after cardiovascular arrest is that basic resuscitation should start immediately. According to the updated guidelines, the greatest efficacy in cardiac massage is only achieved when the right compression point, an adequate compression depth, vertical pressure, the correct frequency, and equally long phases of compression and decompression are achieved. The very highest priority is placed on restoring continuous circulation. Against this background, standardized continuous chest compression with active decompression has contributed to a favorable outcome in this case. The hydraulically operated and variably adjustable automatic Lund University Cardiac Arrest System (LUCAS) device (Jolife, Lund, Sweden) undoubtedly meets these requirements. This case report describes a 44-year-old patient who – approximately 15 min after the onset of clinical death due to apparent ventricular fibrillation – received cardiopulmonary resuscitation, initially by laypersons and then by the emergency medical team (manual chest compressions followed by situation-adjusted LUCAS compressions). Sinus rhythm was restored after more than 90 min of continuous resuscitation, with seven defibrillations. Interventional diagnostic workup did not reveal a causal morphological correlate for the condition on coronary angiography. After a 16-day period of hospital convalescence, with preventive implantation of an implantable cardioverter defibrillator and several weeks of rehabilitation, the patient was able to return home with no evidence of health impairment.

Keywords: resuscitation, cardiac arrest, cardiac massage, LUCAS