Cardiopulmonary resuscitation with a novel chest compression device in a porcine model of cardiac arrest
Improved hemodynamics and mechanisms
Henry R. Halperin, MD, MA*, , ,*,
Norman Paradis, MD ,
Joseph P. Ornato, MD, FACC||,
Menekhem Zviman, PhD*,
Jennifer LaCorte, RN*,
Albert Lardo, PhD* and
Karl B. Kern, MD, FACC¶
* Johns Hopkins University, Department of Medicine, Baltimore, Maryland
Johns Hopkins University, Department of Radiology, Baltimore, Maryland
Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland
University of Colorado Health Science Center, Denver, Colorado
|| Virginia Commonwealth University, Richmond, Virginia
¶ University of Arizona, Tucson, Arizona
Manuscript received May 15, 2004;
revised manuscript received July 20, 2004,
accepted August 23, 2004.
* Reprint requests and correspondence: Dr. Henry Halperin, Johns Hopkins Hospital, Blalock 524, 600 North Wolfe Street, Baltimore, Maryland 21205
(Email: hhalper{at}jhmi.edu).
OBJECTIVES: The goal of this study was to determine the magnitude and mechanisms of hemodynamic improvement of an automated, load-distributing band device (AutoPulse, Revivant Corp., Sunnyvale, California) compared with conventional cardiopulmonary resuscitation (C-CPR).
BACKGROUND: Improved blood flow during cardiopulmonary resuscitation (CPR) enhances survival from cardiac arrest.
METHODS: AutoPulse CPR (A-CPR) and C-CPR were performed on 30 pigs (16 ± 4 kg) 1 min after induction of ventricular fibrillation. Aortic and right atrial pressures were measured with micromanometers. Regional flows were measured with microspheres; A-CPR and C-CPR were performed with 20% anterior-posterior chest compression, with (n = 10) and without (n = 10) epinephrine. A pressure transducer was advanced down the airways during chest compressions (n = 10), and magnetic resonance imaging (MRI) was performed.
RESULTS: AutoPulse CPR improved coronary perfusion pressure (CPP) (aortic – right atrial pressure) without epinephrine (A-CPR 21 ± 8 mm Hg vs. C-CPR 14 ± 6 mm Hg, mean ± SD, p < 0.0001) and with epinephrine (A-CPR 45 ± 11 mm Hg vs. C-CPR 17 ± 6 mm Hg, p < 0.0001). AutoPulse CPR improved myocardial flow without epinephrine and cerebral and myocardial flow with epinephrine (p < 0.05). AutoPulse CPR also produced greater myocardial flow at every CPP (p < 0.01). With A-CPR, high airway pressure was noted distal to the carina, which corresponded to an area of airway collapse on MRI, and which was not present with C-CPR.
CONCLUSIONS: AutoPulse CPR improved hemodynamics over C-CPR in this pig model. AutoPulse CPR with epinephrine can produce pre-arrest levels of myocardial and cerebral flow. The improved hemodynamics with A-CPR appear to be mediated through airway collapse, which likely impedes airflow and helps maintain higher levels of intrathoracic pressure.
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Abbreviations and Acronyms
| | A-CPR = AutoPulse cardiopulmonary resuscitation | | CPP = coronary perfusion pressure | | CPR = cardiopulmonary resuscitation | | C-CPR = conventional (piston) cardiopulmonary resuscitation | | LDB = load-distributing band | | MRI = magnetic resonance imaging | | VF = ventricular fibrillation |
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