Continuous Mechanical Chest Compression-assisted Percutaneous Coronary Intervention in a Patient with Cardiac Arrest Complicating Acute Myocardial Infarction

Cardiac arrest with ventricular tachycardia or ventricular fibrillation in the catheterization laboratory is not uncommon, but patients who suffered cardiac arrest requiring prolonged cardiopulmonary resuscitation is not infrequent and still a major problem, because it is essentially impossible to perform effective manual chest compressions during percutaneous coronary interventions (PCIs). [1] Recently, the use of a novel mechanical chest compression device, Lund University Cardiopulmonary Assist System (LUCAS, Jolife AB, Lund, Sweden), has been shown to sustain both coronary and cerebral circulation despite cardiac arrest and it may be possible to allow for continued PCI despite ongoing cardiac or circulatory arrest with artificially sustained circulation. [2] We here report a case who presented with acute myocardial infarction complicated by cardiac arrest undergoing successful PCI while continuous mechanical chest compression with LUCAS device. A 47‑year‑old male was admitted to our hospital with a 5 h history of chest pain. His initial vital signs included temperature 36.4°C, heart rate 108 beats/min, blood pressure 74/42 mmHg, respiratory rate 22 breaths/min. The initial electrocardiogram revealed sinus tachycardia with ST‑segment elevation in leads V1 through V5. Bedside transthoracic echocardiography showed that hypokinesia of the anterior wall motion and left ventricular ejection fraction was 35%. The blood tests revealed a leukocyte level of 15.91 × 10 9 /L and the serum levels of troponin I of 0.115 ng/ml (normal range 0–0.04 ng/ml). Since the patient was diagnosed as acute ST‑segment elevation myocardial infarction complicated by cardiogenic shock, we decided to emergency PCI. Initial treatment was managed on intravenous dopamine, oral aspirin, clopidogrel, and intravenous unfractionated heparin. About 20 min after admission, while the patient was transferred from the emergency room to the catheterization laboratory, he had a witnessed cardiac arrest with ventricular fibrillation in the elevator [Figure 1]. Continuous chest compression and electrical defibrillation were preformed immediately. The ventricular fibrillation was terminated with defibrillation at first, but in a while he developed repetitive prolonged phases of incessant ventricular tachycardia and ventricular fibrillation. In the catheterization laboratory, repeat defibrillation and intravenous epinephrine, antiarrhythmic drugs such as lidocaine, amiodarone, and magnesium sulfate also could not control the ventricular tachyarrhythmias. His hemodynamic status continued to worsen and required continuous chest compressions and tracheal intubation. Because implantation of extracorporeal membrane oxygenation (ECMO) required surgeons and perfusionists, and they couldn't quickly arrive at the catheterization laboratory, the ECMO could not be performed in the first. LUCAS device was first used for continuous mechanical …