Mechanical CPR - Assisted Percutaneous Coronary Intervention During Cardiac Arrest: Feasibility and Outcomes

Cardiac arrest complicating acute coronary syndromes requires immediate coronary reperfusion; however, performing percutaneous coronary intervention (PCI) during active manual cardiopulmonary resuscitation (CPR) presents significant technical challenges. The Lund University Cardiac Arrest System (LUCAS) provides automated mechanical chest compressions and enables uninterrupted CPR during coronary angiography and PCI. Existing evidence is primarily limited to case reports and small observational studies, mechanical CPR has emerged as a practical adjunct in catheterization laboratories where manual compressions are unsafe or logistically challenging. We report two cases from our center in which LUCAS-assisted PCI was performed during ongoing cardiac arrest in the setting of cardiogenic shock and acute coronary syndromes, alongside a structured narrative synthesis of contemporary literature addressing feasibility, procedural considerations, and clinical outcomes. Mechanical chest compressions allowed uninterrupted angiography and successful revascularization in both cases, with return of spontaneous circulation achieved in one patient. Despite procedural success, survival remained poor, reflecting severe global ischemia and metabolic derangement. LUCAS-assisted PCI is a technically feasible strategy that facilitates coronary reperfusion in carefully selected patients. Evidence of survival benefit remains limited and derives predominantly from observational studies and case reports rather than randomized controlled trials. The role of extracorporeal CPR (ECPR) as a complementary or alternative strategy warrants explicit consideration at appropriately resourced centers. Improved patient selection and integration into structured resuscitation pathways may enhance clinical outcomes.