Giraud Raphaël, Siegenthaler Nils, Schussler Olivier, Kalangos Afksendiyos, Müller Hajo, Bendjelid Karim, Banfi Carlo
Intensive Care Service, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Geneva Hemodynamic Research Group, Geneva, Switzerland.
Intensive Care Service, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Geneva Hemodynamic Research Group, Geneva, Switzerland.
Ann Emerg Med. 2015 Jan;65(1):23-6. doi: 10.1016/j.annemergmed.2014.01.020. Epub 2014 Feb 13.
Survival after cardiac arrest depends on prompt and effective cardiopulmonary resuscitation (CPR). Resuscitative teams are more frequently using mechanical chest compression devices, as documented in physiologic and experimental data, suggesting that these devices are more effective than manual CPR. A 41-year-old male patient presented with an ST-elevation myocardial infarction with cardiac arrest. The patient was immediately resuscitated by manual chest compressions; CPR was continued with a mechanical chest compression device (LUCAS 2). The patient had experienced a 15-minute period of "low-flow" without "no-flow" episode. After a discussion with the heart team, we decided that the patient was a candidate for extracorporeal membrane oxygenation (ECMO) therapy. During the ECMO implantation, we noticed that while performing transesophageal echocardiography, chest compressions were ineffective with the machine. After the ECMO implantation, we observed myocardial damage in the right-sided heart cavities. The present case report illustrates the likelihood that the mechanical chest compression device has limitations that might contribute to inadequate CPR. Therefore, rescuers should consider the efficacy of their chest compression through a continuous hemodynamic monitoring during CPR.
心脏骤停后的存活取决于及时有效的心肺复苏（CPR）。复苏团队越来越频繁地使用机械胸外按压设备，生理和实验数据表明，这些设备比徒手CPR更有效。一名41岁男性患者因ST段抬高型心肌梗死伴心脏骤停就诊。患者立即通过徒手胸外按压进行复苏；使用机械胸外按压设备（LUCAS 2）继续进行CPR。患者经历了15分钟的“低流量”期，无“无流量”发作。与心脏团队讨论后，我们决定该患者适合接受体外膜肺氧合（ECMO）治疗。在植入ECMO期间，我们注意到在进行经食管超声心动图检查时，机器进行胸外按压无效。植入ECMO后，我们观察到右侧心腔出现心肌损伤。本病例报告表明，机械胸外按压设备可能存在局限性，可能导致CPR不充分。因此，救援人员应在CPR期间通过持续的血流动力学监测来考虑胸外按压的效果。
