Effect of different compression--decompression cycles on haemodynamics during ACD-CPR in pigs.

The haemodynamic effects of variations in the relative duration of the compression and active decompression (4 cm/2 cm) during active compression-decompression cardiopulmonary resuscitation (ACD-CPR), 30/70, 50/50 and 70/30, were tested in a randomized cross-over design during ventricular fibrillation in seven anaesthetized pigs (17-23 kg) using an automatic hydraulic chest compression-decompression device. Duty cycles of 50/50 and 70/30 gave significantly higher values than 30/70 for mean carotid blood flow (32 and 36 vs. 21 ml min-1, transit time flow probe, cerebral blood flow (30 and 34 vs. 19, radionuclide microspheres), mean aortic pressure (35 and 41 vs. 29 mmHg) and mean right atrial pressure (24 and 33 vs. 16 mmHg). A higher mean aortic, mean right atrial and mean left ventricular pressure for 70/30 were the only significant differences between 50/50 and 70/30. There were no differences in myocardial blood flow (radionuclide microspheres) or coronary perfusion pressure (CPP, aortic-right atrial pressure) between the three different duty cycles. CPP was positive in both the early and late compression period and during the whole decompression period. The expired CO2 was significantly higher with 70/30 than 30/70 during the compression phase of ACD-CPR. Beyond that no significant differences in the expired CO2 levels were observed. In conclusion a reduction of the compression period to 30% during ACD-CPR reduced the cerebral circulation, the mean aortic and right atrial pressures with no effect on the myocardial blood flow of varying the compression-decompression cycle.

[1]  K. Lurie,et al.  Comparison of exertion required to perform standard and active compression-decompression cardiopulmonary resuscitation. , 1995, Resuscitation.

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

[3]  M. Weil,et al.  Expired carbon dioxide: a noninvasive monitor of cardiopulmonary resuscitation. , 1988, Circulation.

[4]  P. Iversen,et al.  Local blood flow and glucose uptake within resting and exercising rabbit skeletal muscle. , 1991, The American journal of physiology.

[5]  M. Weil,et al.  End-tidal carbon dioxide concentration during cardiopulmonary resuscitation. , 1988, The New England journal of medicine.

[6]  P Vaagenes,et al.  Cerebral resuscitation from cardiac arrest: pathophysiologic mechanisms. , 1996, Critical care medicine.

[7]  T. J. Appleton,et al.  Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. , 1990, JAMA.

[8]  K. Lurie.  Active compression-decompression CPR: a progress report. , 1994, Resuscitation.

[9]  L. Wik,et al.  The first European pre-hospital active compression-decompression (ACD) cardiopulmonary resuscitation workshop: a report and a review of ACD-CPR. , 1995, Resuscitation.

[10]  L. Wik,et al.  Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) compared with standard CPR in a manikin model--decompression force, compression rate, depth and duration. , 1997, Resuscitation.

[11]  W. Dick,et al.  Active compression-decompression resuscitation: a prospective, randomized study in a two-tiered EMS system with physicians in the field. , 1996, Resuscitation.

[12]  C. White,et al.  Active compression-decompression CPR improves vital organ perfusion in a dog model of ventricular fibrillation. , 1994, Chest.

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

[14]  M. Callaham,et al.  Evaluation of active compression-decompression CPR in victims of out-of-hospital cardiac arrest. , 1994, JAMA.

[15]  M. Hunt.  End-tidal carbon dioxide concentration during cardiopulmonary resuscitation: Falk JL, Rackow EC, Weil MH N Engl J Med 318:607–611 Mar 1988 , 1988 .

[16]  P. Steen,et al.  Quality of mechanical, manual standard and active compression-decompression CPR on the arrest site and during transport in a manikin model. , 1997, Resuscitation.

[17]  M. C. Rogers,et al.  Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs. , 1984, Circulation.

[18]  F. Fedele,et al.  Metabolic response to prolonged reduction of myocardial blood flow distal to a severe coronary artery stenosis. , 1988, Circulation.

[19]  J. Bahr,et al.  ACD versus standard CPR in a prehospital setting. , 1996, Resuscitation.

[20]  R. Weiskopf,et al.  Pharmacokinetics of Desflurane, Sevoflurane, Isoflurane, and Halothane in Pigs , 1990, Anesthesia and analgesia.

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

[22]  M. Gizzi,et al.  Benefit of active compression-decompression cardiopulmonary resuscitation as a prehospital advanced cardiac life support. A randomized multicenter study. , 1997, Circulation.

[23]  Keith G. Lurie,et al.  Evaluation of standard and active compression-decompression CPR in an acute human model of ventricular fibrillation. , 1994 .

[24]  S Lemeshow,et al.  Factors affecting the performance of the models in the Mortality Probability Model II system and strategies of customization: a simulation study. , 1996, Critical care medicine.

[25]  P. Carli,et al.  End-Tidal Carbon Dioxide During Out-of-Hospital Cardiac Arrest Resuscitation: Comparison of Active Compression-Decompression and Standard CPR☆☆☆★★★ , 1995 .

[26]  Effects of active compression-decompression resuscitation on myocardial and cerebral blood flow in pigs. , 1993 .

[27]  G A Ewy,et al.  Myocardial perfusion pressure: a predictor of 24-hour survival during prolonged cardiac arrest in dogs. , 1988, Resuscitation.

[28]  M. Weil,et al.  Cardiac output and end‐tidal carbon dioxide , 1985, Critical care medicine.

[29]  M. Chin,et al.  Active compression-decompression. A new method of cardiopulmonary resuscitation. Cardiopulmonary Resuscitation Working Group. , 1992, JAMA.

[30]  L. Ekström,et al.  Hospital mortality after out-of-hospital cardiac arrest among patients found in ventricular fibrillation. , 1995, Resuscitation.

[31]  A. Laupacis,et al.  The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in-hospital and prehospital cardiac arrest. , 1996, JAMA.

[32]  J. Schüttler,et al.  Guidelines for basic life support , 1992 .

[33]  J I Hoffman,et al.  Blood flow measurements with radionuclide-labeled particles. , 1977, Progress in cardiovascular diseases.

[34]  P. Steen,et al.  Effects of various degrees of compression and active decompression on haemodynamics, end-tidal CO2, and ventilation during cardiopulmonary resuscitation of pigs. , 1996, Resuscitation.

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

[36]  W. M. Tucker,et al.  Importance of prolonged compression during cardiopulmonary resuscitation in man. , 1977, The New England journal of medicine.

[37]  P. Steen,et al.  Simultaneous active compression-decompression and abdominal binding increase carotid blood flow additively during cardiopulmonary resuscitation (CPR) in pigs. , 1994, Resuscitation.