Assistant Professor University of Alabama at Birmingham, United States
Introduction: The introduction of mechanical external compression devices, specifically the LUCAS device, has been shown to provide timely and effective CPR. While it is mostly used in the outpatient setting, not much use has been given in the critical care unit (ICU). Here we report the details on a complex case that benefited from the LUCAS device in the ICU after a long period of hand assisted CPR.
Description: A 61-year-old male patient was scheduled for elective left heart catheterization (LHC). Prior to the procedure, the patient went into respiratory distress followed by cardiac arrest secondary to ventricular fibrillation. Manual chest compressions and double defibrillator defibrillations were provided without ROSC. After 30 minutes, all providers were tired of providing compressions, and compressions were not effective. The LUCAS device was initiated, and compressions were effective with the arterial line tracing showed a near perfect wave form. The patient developed ROSC and woke up. After the LUCAS, contraction was not detected on bedside echocardiogram, so LUCAS was re-initiated. The patient was sedated and the placed on venoarterial extra corporeal membrane oxygenation (ECMO). Subsequently a LHC was performed that showed total occlusion of the left anterior descending artery and severe stenosis of the left main artery. The patient was brought back to the ICU in adequately stable conditions on ECMO and an intra-aortic balloon pump. The patient was eventually weaned off ECMO and inotropic support, and had two episodes of septic shock, one due to pneumonia and another due to secondary to a right groin infection from the cannula. Eventually, the patient was discharged to rehabilitation with a LifeVest with plans to place an AICD.
Discussion: The LUCAS was a vital tool in a successful resuscitation. The consistency in both timing and depth allows for, what seems close to perfect quality compression alike to the heart’s own contractions. Its use should be considered in the ICU, providing time for providers to find a cause for the cardiac arrest. However, it is not without limitations: inadequate patient anatomy, potential complications of liver damage secondary to compressions, and the lack of training may prevent providers from using the LUCAS or other external chest compression devices.
