Return of spontaneous circulation and neurological outcome after inhospital Lund University Cardiac Arrest System cardiopulmonary resuscitation

Introduction

We report return of spontaneous circulation (ROSC) and neurological outcome after inhospital Lund University Cardiac Arrest System cardiopulmonary resuscitation (LUCAS-CPR).

Methods

From February 2006 onwards, we intended to use LUCAS-CPR for all cases of adult inhospital arrest, after arrival of the inhospital emergency team. The Glasgow Coma Scale (GCS) was used to determine neurological outcome 24 hours after discontinuing sedative drugs. Outcome at 3 and 6 months was determined by the Cerebral Performance Categories (CPC) [1].

Results

Seventy-two patients received inhospital LUCAS-CPR. Twenty-two were female. The mean age was 71.46 (SD ± 11.9) years. The location of arrest was a monitored ward in 28 cases (emergency department, coronary care unit, ICU) and a general ward in 44. All but three arrests were witnessed. Because of obesity, LUCAS-CPR could not be initiated in three patients. First rhythm was asystole in 15 patients (20.8%), pulseless electrical activity in 40 (55.5%) and ventricular tachycardia/ventricular fibrillation in 17 cases (23.6%). ROSC was obtained in 46 of 72 patients (63.8%). The GCS was favourable (14 or 15/15) in 25 cases (34.7%). The CPC at 3 months revealed a CPC of one in seven patients (9.7%) and of two in 10 patients (13.9%). One patient had a CPC of 3 and one patient a CPC of 4. The CPC at 6 months was slightly different. One patient with a CPC of 1 died, one patient with a CPC of 3 changed to a CPC of 2 after revalidation, and finally one patient with a CPC of 3 died.

Conclusion

LUCAS-CPR is a good alternative for manual closed-chest compression in patients with inhospital cardiac arrest. The ROSC ratio (63,8%) and early neurologic outcome as determined by the GCS (34.7%) are high. CPC at 3 and 6 months revealed a good outcome (CPC 1 or 2) in 23.6%.