Complications of mechanical chest compression devices

A 77-year-old woman was found on the street, next to her bike. She appeared to be unconscious, suffering from head injury and had no detectable pulse. Chest compressions were initiated by bystanders until the ambulance arrived. Pulse-less electrical activity (PEA) was observed and a mechanical chest compression device (LUCAS: Lund University Cardiopulmonary Assist System, Jolife, Sweden, Fig. 1) was positioned to deliver chest compressions. Manual mask ventilation was difficult to apply and several attempts were required for tracheal intubation. After two doses of 1 mg of epinephrine return of spontaneous circulation (ROSC) was established. Upon a r r i va l a t t h e hosp i t a l , s he r ema ined haemodynamically unstable and a swollen and firm abdomen was observed. Chest radiography revealed massive subdiapharmatic free air (Fig. 2). Emergent laparotomy was performed, which showed a few holes in the stomach indicating blowout injury. At that time, there was no injury to the liver, spleen, or intestines. After performing a resection of the gastric minor curvature, she became clinically stable. During the following days, however, progressive clinical deterioration ensued due to intestinal ischaemia and two more laparotomies were performed. Because of ongoing deterioration, further treatment was terminated after which she died. Discussion