Complications of mechanical chest compression devices

CaseA 77-year-old woman was found on the street, next to herbike. She appeared to be unconscious, suffering from headinjury and had no detectable pulse. Chest compressions wereinitiated bybystandersuntil theambulancearrived.Pulse-lesselectrical activity (PEA) was observed and a mechanicalchest compression device (LUCAS: Lund UniversityCardiopulmonary Assist System, Jolife, Sweden, Fig. 1)waspositioned to deliver chest compressions. Manual maskventilation was difficult to apply and several attempts wererequired for tracheal intubation. After two doses of 1 mg ofepinephrine return of spontaneous circulation (ROSC) wasestablished.Upon arrival at the hospital, she remainedhaemodynamically unstable and a swollen and firm abdomenwas observed. Chest radiography revealed massivesubdiapharmatic free air (Fig. 2). Emergent laparotomy wasperformed, which showed a few holes in the stomachindicating blowout injury. At that time, there was no injuryto the liver, spleen, or intestines. After performing a resectionof the gastric minor curvature, she became clinically stable.During the following days, however, progressive clinicaldeteriorationensuedduetointestinal ischaemiaandtwomorelaparotomies were performed. Because of ongoingdeterioration, further treatment was terminated after whichshe died.DiscussionMechanical chest compression devices (MCCDs) areincreasingly used during cardiopulmonary resuscitation(CPR) and they ensure continuous compressions of highquality, even during transportation [1]orduringproceduressuch as percutaneous interventions [2]. Experimental trialshaveshownimprovedorganperfusioncomparedwithmanualchest compressions in pigs, [3, 4] but a pilot study inhumans did not indicate improvement in early survival inout-of-hospital cardiac arrest [5]. Two larger, prospectiveclinical trials on outcome are ongoing: the LINCtrial (NCT00609778) and the PARAMEDIC trial(ISRCTN08233942) [6].Buschmann et al. described an association betweenmanual chest compressions and various injuries. Rib and