Evaluation of Standard and Active Compression‐Decompression CPR in an Acute Human Model of Ventricular Fibrillation

BackgroundThe mechanisms that underlie cardiopulmonary resuscitation (CPR) in humans remain controversial and difficult to study. This report describes a new human model to evaluate CPR during the first 1 to 2 minutes after the onset of ventricular fibrillation (VF). With this model, standard CPR was compared with active compression-decompression (ACD) CPR, a method that uses a handheld suction device to actively compress and actively decompress the chest. Methods and ResultsDuring routine inductions of VF as part of a transvenous lead cardioverter/defibrillator implantation procedure, CPR was performed in 21 patients if the first defibrillation shock failed and until a successful rescue shock was delivered. Compressions during CPR were performed according to American Heart Association guidelines. For ACD CPR, decompression was performed with up to −30 lbs. Radial arterial and right atrial pressures were measured in all patients. Esophageal pressures, intratracheal pressures, or minute ventilation was measured in the last 13 patients. Application of both CPR techniques increased arterial and right atrial pressures. The mean coronary perfusion pressure was increased throughout the entire CPR cycle with ACD CPR (compression, 21.5±9.0 mm Hg; decompression, 21.9±8.7 mm Hg) compared with standard CPR (compression, 17.9±8.2 mm Hg; decompression, 18.5 ±6.9 mm Hg; P < .02 and P < .02, respectively). Ventilation per compression-decompression cycle was 97.3±65.6 mL with standard CPR and 168.4±68.6 mL with ACD CPR (n=7, P < .001). Negative inspiratory pressure was −0.8±4.8 mm Hg with standard CPR and −11.4±6.3 mm Hg with ACD CPR (n=6, P < .04). ConclusionsPatients undergoing multiple inductions of VF during cardioverter/defibrillator implantation with transvenous leads provide a well-controlled and reproducible model to study the mechanisms of CPR. Using this model, ACD CPR significantly increased arterial blood pressure, coronary perfusion pressure, minute ventilation, and negative inspiratory pressure compared with standard CPR.

[1]  M. Weil,et al.  Echocardiographic observations during cardiopulmonary resuscitation: A preliminary report , 1985, Critical care medicine.

[2]  W. B. Kouwenhoven,et al.  Closed-chest cardiac massage. , 1960, JAMA.

[3]  M. Callaham,et al.  Active compression-decompression : a new method of cardiopulmonary resuscitation , 1992 .

[4]  C. Berryman,et al.  Interposed abdominal compression-CPR in human subjects. , 1984, Annals of emergency medicine.

[5]  H. Halperin,et al.  Vital Organ Perfusion During Assisted Circulation by Manipulation of Intrathoracic Pressure , 1991, Circulation.

[6]  B. White,et al.  Perfusion of the cerebral cortex by use of abdominal counterpulsation during cardiopulmonary resuscitation. , 1984, The American journal of emergency medicine.

[7]  M. Callaham,et al.  Active compression-decompression resuscitation: a novel method of cardiopulmonary resuscitation. , 1992, American heart journal.

[8]  June A. Castell,et al.  Esophageal manometry in 95 healthy adult volunteers , 1987, Digestive Diseases and Sciences.

[9]  G. Ewy,et al.  Coronary perfusion pressure during cardiopulmonary resuscitation. , 1985, The American journal of emergency medicine.

[10]  J. Nunn,et al.  Anatomical subdivisions of the volume of respiratory dead space and effect of position of the jaw. , 1959, Journal of applied physiology.

[11]  George A. Johnson,et al.  Implantable transvenous cardioverter-defibrillators. , 1993, Circulation.

[12]  P. Safar,et al.  A comparison of standard, “MAST” ‐augmented, and open‐chest CPR in dogs: A preliminary investigation , 1980, Critical care medicine.

[13]  C. Babbs,et al.  Intrapulmonary epinephrine during prolonged cardiopulmonary resuscitation: improved regional blood flow and resuscitation in dogs. , 1984, Annals of emergency medicine.

[14]  M. Weisfeldt,et al.  Augmentation of carotid flow during cardiopulmonary resuscitation by ventilation at high airway pressure simultaneous with chest compression. , 1981, The American journal of cardiology.

[15]  K. Lurie,et al.  CPR: the P stands for plumber's helper. , 1990, JAMA.

[16]  K. Lindner,et al.  Effects of active compression-decompression resuscitation on myocardial and cerebral blood flow in pigs. , 1993, Circulation.

[17]  J. Redding,et al.  "Old" and "new" CPR manually performed in dogs. , 1981, Critical care medicine.

[18]  Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). , 1980, JAMA.

[19]  M. Weisfeldt,et al.  Mechanisms of Blood Flow During Cardiopulmonary Resuscitation , 1980, Circulation.

[20]  J. B. Sack,et al.  Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. , 1992, JAMA.

[21]  M S Eisenberg,et al.  Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. , 1980, The New England journal of medicine.

[22]  W. Weaver,et al.  Hemodynamics in humans during conventional and experimental methods of cardiopulmonary resuscitation. , 1988, Circulation.

[23]  M. Elliott.  Successful resuscitation from cardiac arrest using high-dose epinephrine therapy , 1989 .

[24]  R. Nowak,et al.  Aortic and right atrial pressures during standard and simultaneous compression and ventilation CPR in human beings. , 1986, Annals of emergency medicine.

[25]  M H Weil,et al.  Simultaneous aortic, jugular bulb, and right atrial pressures during cardiopulmonary resuscitation in humans. , 1990, Circulation.

[26]  H. Halperin,et al.  Vest inflation without simultaneous ventilation during cardiac arrest in dogs: improved survival from prolonged cardiopulmonary resuscitation. , 1986, Circulation.

[27]  W. Tacker,et al.  Regional blood flow during cardiopulmonary resuscitation in dogs , 1980, Critical care medicine.

[28]  P. Safar,et al.  Comparison of standard and "new" closed-chest CPR and open-chest CPR in dogs. , 1981, Critical care medicine.

[29]  M. C. Rogers,et al.  Augmentation of Cerebral Perfusion by Simultaneous Chest Compression and Lung Inflation with Abdominal Binding After Cardiac Arrest in Dogs , 2005 .

[30]  J. Criley,et al.  Cough-induced cardiac compression. Self-administered from of cardiopulmonary resuscitation. , 1976, JAMA.

[31]  J. Mcdonald.  Systolic and mean arterial pressures during manual and mechanical CPR in humans. , 1981, Annals of emergency medicine.

[32]  C. Rhodes,et al.  Relative Lack of Coronary Blood Flow During Closed‐chest Resuscitation in Dogs , 1982, Circulation.

[33]  B. Janiak,et al.  Interposed abdominal compression-CPR: its effects on parameters of coronary perfusion in human subjects. , 1985, Annals of emergency medicine.

[34]  E F Cook,et al.  Survival after cardiopulmonary resuscitation in the hospital. , 1984, The New England journal of medicine.