Sudden cardiac arrest is a devastating manifestation of coronary artery disease and a leading cause of death in the western world. Early and effective cardiopulmonary resuscitation is essential for return of spontaneous circulation. If manual compression is ongoing and return of spontaneous circulation has not been achieved, the prognosis is poor, and the logistics of performing cardiac catheterization are forbidding. With the advent of mechanical chest compression, however, this clinical scenario has become much more complex. Coronary angiography and percutaneous coronary intervention, although still cumbersome, has been established as feasible with ongoing mechanical chest compression. This article discusses the strengths and pitfalls of mechanical cardiopulmonary resuscitation, our experience, and current evidence behind activation of the catheterization laboratory with ongoing mechanical chest compression.

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Background Rheumatic heart disease affects 33 million people in low and middle income countries and is the leading cause of cardiovascular death among children and young adults. Penicillin prophylaxis has been shown to improve valvular function among patients with clinically silent or mild disease. Efforts to expand echocardiographic screening are focusing on simplified protocols, non-physician ultrasonographers, and portable ultrasound devices, including handheld ultrasound. Recent advances support the use of single-view screening protocols. With the increasing availability and low cost of handheld devices, prospective studies are needed to evaluate their performance in these settings. Methods We conducted a cross-sectional study among 19 at-risk school-children participating in a rheumatic heart disease screening program in Ethiopia comparing a handheld ultrasound device (Phillips Lumify) to a fully-equipped portable ultrasound machine (Sonosite M-Turbo). Results Agreement between devices was similar for expert and non-expert review (84%). However, when reviewed by a non-expert the Lumify identified fewer screen-positive cases (p-value 0.083). We also compared non-expert to expert interpretation by device and found a significant difference in interpretation for the Lumify (p-value 0.025). There was a trend towards shorter jet length by color Doppler in the handheld ultrasound device for both expert and non-expert review. Conclusions Our study highlights the importance of using caution when applying proposed single-view criteria as the sensitivity and specificity may be affected by the device.