A look inside cardiopulmonary resuscitation: A 4D computed tomography model of simulated closed chest compression. A proof of concept

Computed tomography (CT) represents the current standard for imaging of patients with acute life-threatening diseases. As some patients present with circulatory arrest, they require cardiopulmonary resuscitation. Automated chest compression devices are used to continue resuscitation during CT examinations, but tend to cause motion artifacts degrading diagnostic evaluation of the chest. The aim was to investigate and evaluate a CT protocol for motion-free imaging of thoracic structures during ongoing mechanical resuscitation. The standard CT trauma protocol and a CT protocol with ECG triggering using a simulated ECG were applied in an experimental setup to examine a compressible thorax phantom during resuscitation with two different compression devices. Twenty-eight phantom examinations were performed, 14 with AutoPulse® and 14 with corpuls cpr®. With each device, seven CT examinations were carried out with ECG triggering and seven without. Image quality improved significantly applying the ECG-triggered protocol (p < 0.001), which allowed almost artifact-free chest evaluation. With the investigated protocol, radiation exposure was 5.09% higher (15.51 mSv vs. 14.76 mSv), and average reconstruction time of CT scans increased from 45 to 76 s. Image acquisition using the proposed CT protocol prevents thoracic motion artifacts and facilitates diagnosis of acute life-threatening conditions during continuous automated chest compression.

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Monitoring chest compression quality during cardiopulmonary resuscitation: Proof-of-concept of a single accelerometer-based feedback algorithm

PLoS ONE ◽

10.1371/journal.pone.0192810 ◽

2018 ◽

Vol 13 (2) ◽

pp. e0192810 ◽

Cited By ~ 1

Author(s):

Digna María González-Otero ◽

Jesus María Ruiz ◽

Sofía Ruiz de Gauna ◽

Jose Julio Gutiérrez ◽

Mohamud Daya ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Proof Of Concept ◽

Feedback Algorithm

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Retrospective Study Using Computed Tomography to Compare Sufficient Chest Compression Depth for Cardiopulmonary Resuscitation in Obese Patients

Journal of the American Heart Association ◽

10.1161/jaha.119.013948 ◽

2019 ◽

Vol 8 (23) ◽

Author(s):

Heekyung Lee ◽

Jaehoon Oh ◽

Juncheol Lee ◽

Hyunggoo Kang ◽

Tae Ho Lim ◽

...

Keyword(s):

Computed Tomography ◽

Retrospective Study ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Obese Patients ◽

Compression Depth

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Forward blood ﬂow provoked by changing intravascular pressure using an extracorporeal circulation during cardiopulmonary resuscitation

10.22514/sv.2020.16.0082 ◽

2020 ◽

Keyword(s):

Blood Flow ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Intrathoracic Pressure ◽

Arterial Blood Flow ◽

Systemic Blood ◽

Systemic Blood Flow ◽

Closed Chest ◽

Arterial Blood ◽

Intravascular Pressure

Since both “cardiac pump” and “thoracic pump” theories have been proved during cardiopulmonary resuscitation (CPR), the mechanism of forward blood flow during closed chest compression still remains open to question. The cardiac pump seems to work by the direct compression of the cardiac ventricles between the sternum and vertebral column. A pressure gradient created between the ventricle and aorta generates systemic blood flow. However, the thoracic pump mechanism presumes chest compression causes a rise in intrathoracic pressure which generates a blood flow from the thoracic cavity to the systemic circulation. Retrograde blood flow from the right heart into the systemic veins is prevented by a concomitant collapse of veins at the thoracic inlet. We hypothesize that the intrinsic decrease of vascular resistance from the aorta to peripheral arteries and the existence of competent venous valves enable blood to flow unidirectionally by the fluctuation of intravascular pressures during closed chest compression. The purpose of this study is to prove an antegrade arterial blood flow without cardiac compression and intrathoracic pressure changes in an animal cardiac arrest model. We demonstrate that arterial pulses can be developed by using an extracorporeal circuit, resulting in forward blood flow from the aorta through the systemic vasculature. It can be suggested that changes in intravascular pressure provoked by either cardiac or thoracic pump generate systemic blood flow during closed chest compression, while systemic vascular patency and valve function may be required for successful CPR.

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