Unexpected collateral impact after out of hospital resuscitation using LUCAS system
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CASE REPORT
Open Access
Unexpected collateral impact after out of hospital resuscitation using LUCAS system Jasmin Hasmik Shahinian1* , Jonas Quitt2, Mark Wiese3, Friedrich Eckstein1 and Oliver Reuthebuch1
Abstract Background: Mechanical chest compression using a piston device during reanimation is often the only way to ensure stable chest compression at a constant rate and force. However, its use can be associated with severe fractures of the thoracic rib cage and endanger the clinical course of the patient. Thus, the usage of such a piston device during the reanimation has currently been classified as a mere Class IIB indication. Case presentation: We present a case of a 66-year-old male who underwent emergent CABG surgery after receiving out-of-hospital resuscitation as a result of myocardial infarction using the LUCAS system. Due to severe bilateral rib fractures a concomitant emergency chest-wall stabilization surgery had to be performed to ensure uncompromised graft flow to obtain stable cardiac function and hemodynamics. Conclusions: Reanimation using LUCAS-System might enable stable resuscitation conditions. However, it is crucial not to underestimate potential collateral damage which can in turn aggravate patient’s clinical condition. Keywords: Out-of-hospital resuscitation, LUCAS system, Flail chest, Emergency chest wall stabilization
Background Cardiac arrest followed by out-of-hospital resuscitation is a major public concern worldwide [1]. Detailed response mechanisms and protocols are stated in American and European guidelines to ensure correct management. Mechanical chest compression devices such as ‘The Lund University Cardiac Arrest System (LUCAS)’ or ‘Prehospital Randomised Assessment of a Mechanical Compression Device in Cardiac Arrest (PARAMEDIC)’ are so called piston devices, which are positioned over the sternum and compress the chest at a set rate and force. Both devices have been compared to the manual chest compression in PARAMEDIC and LINC trials [2, 3]. Neither of the trials could show a significant benefit from mechanical versus manual CPR (CardioPulmonary Resuscitation). Moreover, the time required for positioning the mechanical compression device prolongs the no-chest compression phase during resuscitation [4]. Hence, manual chest compression remains the standard of care in the resuscitation management of cardiac arrest. The use of mechanical compression devices remains a Class IIB recommendation being * Correspondence: [email protected] 1 Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland Full list of author information is available at the end of the article
limited to special settings where accurate chest compressions cannot be delivered [4]. We present a case of a male patient after out-ofhospital resuscitation with the LUCAS System after cardiac arrest who underwent emergency CABG surgery. Due to the severe flail chest he experienced hemodynamic and respiratory instability with distinct ST-segment alterations cause
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