Towards Personalized Closed-Loop Mechanical CPR: A Model Relating Carotid Blood Flow to Chest Compression Rate and Duration

We have previously reported that transthoracic medium voltage therapy (MVT) generated coronary perfusion pressure (CPP), forward carotid blood flow (CBF) and end-tidal CO 2 (EtCO 2 ) comparable to those produced by manual chest compression. In the present study, we investigated the capability of MVT to generate and maintain forward blood flow for a longer interval, i.e. 1 min, in a porcine model of short duration cardiac arrest. MVT can maintain threshold levels of CPP, CBF and EtCO 2 , for a minute interval prior to defibrillation. In 7 domestic male pigs weighing 40 ± 1 kg, VF was electrically induced and untreated for 10 seconds. Animals were then subjected to receive MVT for one minute with the aid of a Galvani E-CPR device (Galvani Ltd, Edina, MN), after when a biphasic shock was delivered. The MVT pulsed packet was 400 msec, the pulsed packet rate was 80/min, the intra-packet pulse period was 25 ms and intra-packet pulse durations were 0.2 ms. CPP and EtCO2 were continuously measured during MVT. CBF and ejection fraction generated during MVT were measured by echo-Doppler technique, while cardiac output with stroke volume by thermodiluition method. MVT was able to maintain CPP and EtCO2 above the threshold levels for successful resuscitation for the entire interval of application (Table ). During MVT, excellent stroke volume, cardiac output and ejection fraction together with carotid blood flow were generated (Table ). MVT produced and maintained for one minute forward blood flow during cardiac arrest. This electrical therapy might represent a new approach intended to generate and/or maintain forward blood flow in lieu of or in association with chest compression in victims of cardiac arrest

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Why Change the Compression and Ventilation Rates During CPR in Neonates?

PEDIATRICS ◽

10.1542/peds.93.6.1026 ◽

1994 ◽

Vol 93 (6) ◽

pp. 1026-1027

Author(s):

◽

Keyword(s):

Blood Flow ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Cardiac Care ◽

Compression Rate ◽

National Conference ◽

Ventilation Rates

The 1985 American Heart Association National Conference for Emergency Cardiac Care (ECC) recommendations for neonatal cardiopulmonary resuscitation included a chest compression rate of 120/minute accompanied by ventilation at a rate of 40 to 60/minute.1 There was no attempt to coordinate ventilation and compression. Rescuers providing chest compression and those providing ventilation were taught to perform their tasks independently, resulting in frequent simultaneous compression and ventilation. At the time, much of the available data indicated that simultaneous compression and ventilation (SVC-CPR) resulted in improved blood flow.2-6

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Abstract 240: Comparison of Hemodynamics Generated by Synchronized and Interposed Compressions During Treatment of Pseudo Electro-mechanical Dissociation

Circulation ◽

10.1161/circ.142.suppl_4.240 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Joshua W Lampe ◽

Jill K Badin ◽

Lyra Clark ◽

Jeff R Gould ◽

Karen L Moodie ◽

...

Keyword(s):

Heart Rate ◽

Blood Flow ◽

Chest Compression ◽

Right Atrial ◽

Compression Rate ◽

Chest Compressions ◽

Blood Flows ◽

Mechanical Dissociation ◽

Life Threatening ◽

Integrated Or

Introduction: Pseudo electro-mechanical dissociation (P-EMD) is a cardiac arrest variant characterized by a life-threatening reduction in cardiac output in the presence of organized electrical activity. Synchronization of chest compressions to the R-wave in the ECG may be preferable to the delivery of standard CPR. However, in the bradycardic P-EMD state, synchronization may result in inadequate blood flow due to the low compression/heart rate. This pilot study examined the hemodynamic effect of interposing additional chest compressions between synchronized chest compressions during bradycardic P-EMD to increase the compression rate. Methods: P-EMD was induced via hypoxia in three female swine (~30 kg) and treated with synchronized compressions until the onset of asystole (HR<12 BPM). Interposed compressions were added when the heart rate fell below 60 BPM. A chest compression was classified as synchronized or interposed depending on the presence or absence of a co-incident R-wave. Hemodynamic parameters were integrated or averaged over each compression interval. Results: Synchronized compressions tended to produce larger aortic pressures, larger carotid blood flows, and lower right atrial pressures than interposed compressions. Data from one experiment are shown in Figure 1. The relative hemodynamic benefit of a synchronized chest compression appears to depend on the effectiveness of the underlying heart contraction. The interposed chest compressions generated forward carotid blood flow and increased the compression rate during bradycardia. Discussion: During bradycardic P-EMD, synchronized compressions may generate better hemodynamics than interposed compressions, and the combination of synchronized and interposed compressions may result in more blood flow than the delivery of synchronized compressions alone. Figure 1. Comparison of hemodynamics generated by synchronized compressions (blue) and interposed compressions (red).

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Effects of compression rate on rats carotid blood flow

Archives of Physiology and Biochemistry ◽

10.3109/13813459508996133 ◽

1995 ◽

Vol 103 (2) ◽

pp. 196-201 ◽

Cited By ~ 1

Author(s):

Fr. Guerrero ◽

H. Burnet

Keyword(s):

Blood Flow ◽

Compression Rate ◽

Carotid Blood Flow

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Abstract 139: Impedance Threshold Device and Active Decompression Improve Hemodynamics in a Swine Model of Prolonged CPR

Circulation ◽

10.1161/circ.138.suppl_2.139 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Joshua W Lampe ◽

Yin Tai ◽

Anja K Metzger ◽

Christopher L Kaufman ◽

Lance B Becker

Keyword(s):

Blood Flow ◽

Chest Compression ◽

Zero Point ◽

Swine Model ◽

Carotid Blood Flow ◽

Blood Flows ◽

Lift Height ◽

Threshold Device ◽

Acd Cpr ◽

Impedance Threshold Device

Introduction: Cardiopulmonary resuscitation with the impedance threshold device and active decompression (ITD-ACD CPR) has been shown to improve chest compression generated blood flow relative to standard chest compression. Using our high-fidelity swine model of cardiac arrest treated with prolonged mechanical chest compression (MCC) we studied the effect of different lift heights (amount of lift above the natural zero point of the sternum) during active decompression. Methods: CPR was performed on six domestic swine (~30 kg) using standard physiological monitoring. Flow was measured in the abdominal aorta, inferior vena cava (IVC), right common carotid and external jugular, and left femoral artery. Ventricular fibrillation (VF) was electrically induced. MCC were started after ten minutes of VF. Four MCC waveforms were used: Standard CPR (2”, 100 CPM), and ITD-ACD CPR (2”, 80 CPM) with 0.5”, 1.0”, and 1.5” lift past the zero point. MCC waveforms were changed every 2 min in a crossover design and delivered for 56 minutes. Data were analyzed in CPR cycles which included four epochs of CPR, one of each waveform, constituting 8 minutes of compressions. Results: Lift height had a significant (p<0.05) effect on carotid and jugular blood flow. Lift heights of 1.0 and 1.5” generated significantly more carotid blood flow in all 7 CPR cycles. A lift height of 1.5” generated significantly more jugular blood flow over all 7 CPR cycles. The interaction between duration of CPR and Jugular blood flow previously observed using this animal model was not observed. Carotid and jugular blood flow as a function of waveform and CPR cycle are shown in the figure. Conclusions: ITD-ACD CPR improved carotid and jugular blood flows, suggestive of improved cerebral perfusion. A lift height of 1.5” was required for significant improvement of jugular blood flows, while ITD-ACD CPR provided significantly better carotid blood flow than standard CPR at all lift heights.

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An optimal closed-loop control strategy for mechanical chest compression devices: A trade-off between the risk of chest injury and the benefit of enhanced blood flow

Computer Methods and Programs in Biomedicine ◽

10.1016/j.cmpb.2012.04.009 ◽

2012 ◽

Vol 108 (1) ◽

pp. 288-298 ◽

Cited By ~ 4

Author(s):

Guang Zhang ◽

Jie-Wen Zheng ◽

Jian Wu ◽

Tai-Hu Wu

Keyword(s):

Blood Flow ◽

Chest Compression ◽

Control Strategy ◽

Closed Loop ◽

Chest Injury ◽

Closed Loop Control ◽

Trade Off ◽

Loop Control ◽

Mechanical Chest Compression

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Corpuls CPR Generates Higher Mean Arterial Pressure Than LUCAS II in a Pig Model of Cardiac Arrest

BioMed Research International ◽

10.1155/2017/5470406 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

S. Eichhorn ◽

A. Mendoza ◽

A. Prinzing ◽

A. Stroh ◽

L. Xinghai ◽

...

Keyword(s):

Blood Flow ◽

Chest Compression ◽

Near Infrared ◽

Coronary Perfusion Pressure ◽

Spontaneous Circulation ◽

Pig Model ◽

Coronary Perfusion ◽

Organ Perfusion ◽

Chest Compressions ◽

Carotid Blood Flow

According to the European Resuscitation Council guidelines, the use of mechanical chest compression devices is a reasonable alternative in situations where manual chest compression is impractical or compromises provider safety. The aim of this study is to compare the performance of a recently developed chest compression device (Corpuls CPR) with an established system (LUCAS II) in a pig model. Methods. Pigs (n = 5/group) in provoked ventricular fibrillation were left untreated for 5 minutes, after which 15 min of cardiopulmonary resuscitation was performed with chest compressions. After 15 min, defibrillation was performed every 2 min if necessary, and up to 3 doses of adrenaline were given. If there was no return of spontaneous circulation after 25 min, the experiment was terminated. Coronary perfusion pressure, carotid blood flow, end-expiratory CO2, regional oxygen saturation by near infrared spectroscopy, blood gas, and local organ perfusion with fluorescent labelled microspheres were measured at baseline and during resuscitation. Results. Animals treated with Corpuls CPR had significantly higher mean arterial pressures during resuscitation, along with a detectable trend of greater carotid blood flow and organ perfusion. Conclusion. Chest compressions with the Corpuls CPR device generated significantly higher mean arterial pressures than compressions performed with the LUCAS II device.

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Effect of the Use of Metronome Feedback on the Quality of Pediatric Cardiopulmonary Resuscitation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158087 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8087

Author(s):

Dongjun Yang ◽

Wongyu Lee ◽

Jehyeok Oh

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Healthcare Providers ◽

Compression Rate ◽

Audio Feedback ◽

Simple Method ◽

Compression Depth ◽

Pediatric Resuscitation ◽

Cpr Quality

Although the use of audio feedback with devices such as metronomes during cardiopulmonary resuscitation (CPR) is a simple method for improving CPR quality, its effect on the quality of pediatric CPR has not been adequately evaluated. In this study, 64 healthcare providers performed CPR (with one- and two-handed chest compression (OHCC and THCC, respectively)) on a pediatric resuscitation manikin (Resusci Junior QCPR), with and without audio feedback using a metronome (110 beats/min). CPR was performed on the floor, with a compression-to-ventilation ratio of 30:2. For both OHCC and THCC, the rate of achievement of an adequate compression rate during CPR was significantly higher when performed with metronome feedback than that without metronome feedback (CPR with vs. without feedback: 100.0% (99.0, 100.0) vs. 94.0% (69.0, 99.0), p < 0.001, for OHCC, and 100.0% (98.5, 100.0) vs. 91.0% (34.5, 98.5), p < 0.001, for THCC). However, the rate of achievement of adequate compression depth during the CPR performed was significantly higher without metronome feedback than that with metronome feedback (CPR with vs. without feedback: 95.0% (23.5, 99.5) vs. 98.5% (77.5, 100.0), p = 0.004, for OHCC, and 99.0% (95.5, 100.0) vs. 100.0% (99.0, 100.0), p = 0.003, for THCC). Although metronome feedback during pediatric CPR could increase the rate of achievement of adequate compression rates, it could cause decreased compression depth.

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