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
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Figure 1 (A) Timeline for protocol without epinephrine. For blood flow measurements, blood is withdrawn during the times indicated. (B) Timeline for protocol with epinephrine. CPR = cardiopulmonary resuscitation; VF = ventricular fibrillation.
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Figure 2 Operation of the AutoPulse. During compression (left) the band is tightened by the motor, and compression force is directed inward. During relaxation (right), the band is released, and the chest expands.
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Figure 3 (A) Left ventricular flows during protocols without and with epinephrine (Epi). *p < 0.05 vs. conventional (piston) cardiopulmonary resuscitation (C-CPR); **p < 0.01 vs. C-CPR. (B) Brain blood flows during same protocols. **p < 0.05 vs. C-CPR. A-CPR = AutoPulse cardiopulmonary resuscitation.
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Figure 4 Correlations between left ventricular (LV) and brain flows, and coronary perfusion pressure (CPP), for AutoPulse cardiopulmonary resuscitation (A-CPR) and conventional (piston) cardiopulmonary resuscitation (C-CPR). For both the LV and brain, A-CPR produced more flow at given levels of CPP than C-CPR (p < 0.05).
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Figure 5 (A) Recordings during AutoPulse cardiopulmonary resuscitation (A-CPR) before and after airway catheter withdrawal. The catheter was advanced down the airway until high airway pressure was recorded (distal). The catheter was then withdrawn 6 cm, and the lower airway pressure was recorded (proximal). (B) Recordings during conventional (piston) cardiopulmonary resuscitation before and after airway catheter withdrawal. The catheter was manipulated as with A-CPR. All pressures in mm Hg. AO = aortic; RA = right atrial.
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Figure 6 Magnetic resonance imaging of the thorax during AutoPulse cardiopulmonary resuscitation. The trachea is widely patent in the uncompressed state (A, arrow) but is nearly fully collapsed during peak compression (B, arrow).
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