Cardiovascular Business - November/December 2008 - (Page 28)

TECHNOLOGY TRENDS › By C.P. K aiser Get Pumped Up about f Europe is any indication of where mechanical cardiopulmonary resuscitation (CPR) is heading, interventional cardiologists in the U.S. should get ready to welcome the devices into their cath labs. European researchers have begun to validate the technique in arrested patients undergoing PCI. There is a general reluctance to take arrested patients to the cath lab, even though the majority of arrests are cardiac in origin. Two factors emerge as important reasons for this reluctance: unknown brain perfusion, which could lead to a poor outcome or cath lab death, and the challenges to perform CPR during a catheterization procedure, such as radiation exposure to hands or the need to stop frequently. These data are borne from results of a survey of 75 interventional cardiologists conducted at the 2008 American College of Cardiology (ACC) meeting by HRA Associates at the behest of ZOLL Medical, makers of the AutoPulse cardiac support pump. Survey results showed that most cardiologists would consider intervention if adequate blood pressure was attained during resuscitation (65 percent); if they were confident that cerebral perfusion was maintained (85 percent); and if there were a device that could provide near normal perfusion, allow good visualization and perform chest compressions without human intervention (71 percent). However, only 5 percent of respondents had ever used such a device, and only 11 percent had seen one being used. Interventionalists I A B (a) stent placement in patient during LUCas chest compression. (B) TiMi 3 flow in left anterior descending artery after the procedure. source: Kristoff Cornelis, MD, antwerp Cardiovascular institute Middelheim, Belgium Validation of devices Preclinical studies have demonstrated improved hemodynamics when using an automated resuscitation device versus conventional CPR. Clinical studies also have shown the value of such devices with out-of-hospital and in-hospital cardiac arrest patients. Researchers have more recently begun to look at whether arrest patients treated out-of-hospital with mechanical CPR have an improved survival following PCI and whether mechanical CPR during PCI is feasible. Kristoff Cornelis, MD, and colleagues from Antwerp Cardiovascular Institute Middelheim and AZ Maria Middelares in Belgium successfully applied CPR with the LUCAS chest compression device (Physio-Control) to five patients undergoing PCI. The two stable patients completely recovered, while the three unstable patients died, despite successful intervention and application of mechanical CPR. The study was presented at the 2008 European Resuscitation Council Congress. (See images at left) The Belgian researchers reported that the LUCAS device was introduced into their emergency department more than a year ago and has been used in the cath lab during procedures complicated by cardiac arrest and cardiogenic shock or during procedures performed in patients already under mechanical CPR, started out-of-hospital or in the emergency department. Larsen et al from Stavanger University Hospital, Norway, reported that the LUCAS device is suitable during cardiac cath and ensures an adequate systemic blood pressure. In their study, 13 patients within 13 months were treated with PCI while undergoing mechanical CPR (Resuscitation 2007 Dec;75[3]:454-9). The mean systolic and diastolic blood pressure obtained was 81 and 34 mmHg, respectively. Angiography and PCI were possible in all cases during ongoing automatic chest compression and there were no excessive intra-thoracic or intra-abdominal injuries. Three patients survived the procedure, but no patients were discharged alive. Safety, ease of use Several studies have validated the safety of these devices in terms of chest injuries. In one study, Sergio Timerman, MD, 28 Cardiovascular Business November/December 2008

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Cardiovascular Business - November/December 2008 Contents First Word Cover Story: Practice Management Software Moves Beyond Bean Counting The Death of CME as We Know It? Clinical Study Digets: Triple-Antiplatelet Therapy; Ex-Vioxx Users Beware Shockwaves Subside from the FDA's Echo Contract Warning Burning Question: Does Laser Heart Therapy for Angina Really Work? Advanced Visualization Adds New Practive Dimension Coronary Calcium Scoring Program Reaps Dividends Interventionalists Get Pumped Up About Mechanical Chest Compression Trials Force Physicians to Re-Examine Oral Anti-Diabetic Drug Protocols News & Views Calendar Reader Resources The ACC Corner

Cardiovascular Business - November/December 2008

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