Clinical Communications: Adults FULL RECOVERY AFTER PROLONGED CARDIAC ARREST AND RESUSCITATION WITH MECHANICAL CHEST COMPRESSION DEVICE DURING HELICOPTER TRANSPORTATION AND PERCUTANEOUS CORONARY INTERVENTION Alessandro Forti, MD,*†‡ Giovanna Zilio, MD,*†‡ Paolo Zanatta, MD,*† Marialuisa Ferramosca, MD,‡ Cristiano Gatto, PN,‡ Antonio Gheno, PN,‡ and Paolo Rosi, MD‡ *Anesthesia Department, †Intensive Care Department, and ‡Emergency Department, Regional Hospital Treviso, Treviso, Italy Reprint Address: Alessandro Forti, MD, Emergency Department, Regional Hospital Treviso, 31100 Treviso, Italy , Abstract—Background: Despite early cardiopulmonary resuscitation (CPR) by bystanders and early advanced car- diac life support (ACLS) maneuvers, some patients present to the emergency department with persistent cardiac arrest caused by a coronary artery occlusion. Although emergency percutaneous intervention (PCI) has been shown to be effec- tive in improving survival, transporting patients in cardiac arrest to the hospital is not considered to be effective, due to the poor quality of CPR in the ambulance. In the case re- ported here, a mechanical chest compression device was used while transporting the patient by helicopter emergency medical services (HEMS). Case Report: A mechanical chest compression device was used to deliver chest compressions to a 53-year-old man in cardiac arrest. This device permitted the transfer of the patient by HEMS helicopter to the catheterization laboratory facility for a PCI. Return of spontaneous circulation was achieved 115 min after cardiac arrest and the patient survived without any neurological deficit. Why Should an Emergency Physician Be Aware of This?: The mechanical chest compression device has permitted safe and effective CPR during helicopter trans- portation. Although this is only a single case, it may present a new perspective for the treatment of prehospital cardiac arrest that is refractory to ACLS therapies. Ó 2014 Elsevier Inc. , Keywords—LUCAS; mechanical chest compression device; cardiopulmonary resuscitation; HEMS helicopter; emergency percutaneous intervention; survival INTRODUCTION Thanks to educational programs and prearrival instruc- tions by emergency medical services (EMS) dispatching center operators, early cardiopulmonary resuscitation (CPR) delivered by bystanders has become more com- mon over the years, improving the chance of survival af- ter a cardiac arrest. However, despite early CPR and early Advanced Cardiac Life Support (ACLS) by EMS teams, in many patients the return of spontaneous circulation (ROSC) cannot be achieved, due to a recurrent ventricular fibrillation or persistent pulseless electrical activity. In some of these patients, these conditions can be due to a coronary artery occlusion, which maintains the dys- rhythmia or impairs myocardial contractility. Emergency percutaneous coronary intervention (PCI) during cardiac arrest has been demonstrated to improve survival (1). However, because quality of manual CPR during transportation is very poor, it is linked to extremely low survival rates, and can pose significant danger to prehospital providers (2). In such cases, in most EMS systems, termination of resuscitation efforts in the field has been considered to be the only option. The LUCAS-2Ô (Physio-Control/Jolife AB, Lund, Sweden) is a mechanical device that delivers chest com- pressions at a constant rate of 100 compressions per min- ute, to a depth of 4 to 5 cm, using a piston with an attached RECEIVED: 27 November 2013; FINAL SUBMISSION RECEIVED: 1 April 2014; ACCEPTED: 30 June 2014 632 The Journal of Emergency Medicine, Vol. 47, No. 6, pp. 632–634, 2014 Copyright Ó 2014 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2014.06.066