Abstract 69: Evaluation Of Abdominal Blood Flow During Chest Compression In Cardiac Arrest Patients Using Enhanced Computed Tomography (CT)

Background: The mechanism of blood flow during chest compression in cardiac arrest patients remains under investigation. We often experience that cardiac arrest patients suffer severe diarrhea after successful cardiopulmonary resuscitation(CPR), which would be attributable to intestinal ischaemia during cardiac arrest and resuscitation. However, few studies have been made to evaluate abdominal blood flow during chest compression in cardiac arrest patients. Patients and Methods: The study was made in four patients immediately after termination of cardiopulmonary resuscitation. A 100ml bolus of 300 mgI/ml contrast medium was injected from a short femoral vein catheter, followed by continuous chest compression at a rate 100/min. In order to evaluate the distribution of contrast medium, CT images of the chest and abdomen were taken after 100 and/or 200 chest compressions, respectively. Results: CT scans showed similar enhance patterns in the patients. After 100 chest compressions, enhancement values were higher at inferior vena cava(IVC) regions compared to ascending aorta and main arteries. After 200 compressions, enhancement values of the arteries were increased by two to four times. However, significant enhancement of hepatic veins and limited enhancement of portal veins suggest impaired perfusion of the liver and the bowel. Conclusion: One hundred or 200 chest consecutive compressions are not sufficient to enhance abdominal organs including the liver and bowel. Figures: Typical MPR(Multiplanar reconstruction) images after 100compressions at two different coronal planes; hepatic vein and IVC(left), portal veins(right) are depicted.

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Chest compression efficacy of child resuscitators

Journal of Paramedic Practice ◽

10.12968/jpar.2021.13.11.448 ◽

2021 ◽

Vol 13 (11) ◽

pp. 448-455

Author(s):

Tiffany Wai Shan Lau ◽

Anthony Robert Lim ◽

Kyra Anne Len ◽

Loren Gene Yamamoto

Keyword(s):

Blood Flow ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Minimum Weight ◽

Success Rates ◽

Compression Force ◽

Chest Compressions ◽

Traditional Methods ◽

Video Review ◽

Brief Training

Background: Chest compression efficacy determines blood flow in cardiopulmonary resuscitation (CPR) and relies on body mechanics, so resuscitator weight matters. Individuals of insufficient weight are incapable of generating a sufficient downward chest compression force using traditional methods. Aims: This study investigated how a resuscitator's weight affects chest compression efficacy, determined the minimum weight required to perform chest compressions and, for children and adults below this minimum weight, examine alternate means to perform chest compressions. Methods: Volunteers aged 8 years and above were enrolled to perform video-recorded, music-facilitated, compression-only CPR on an audible click-confirming manikin for 2 minutes, following brief training. Subjects who failed this proceeded to alternate modalities: chest compressions by jumping on the lower sternum; and squat-bouncing (bouncing the buttocks on the chest). These methods were assessed via video review. Findings: There were 57 subjects. The 30 subjects above 40kg were all able to complete nearly 200 compressions in 2 minutes. Success rates declined in those who weighed less than 40kg. Below 30 kg, only one subject (29.9 kg weight) out of 14 could achieve 200 effective compressions. Nearly all of the 23 subjects who could not perform conventional chest compressions were able to achieve effective chest compressions using alternate methods. Conclusion: A weight below 40kg resulted in a declining ability to perform standard chest compressions effectively. For small resuscitators, the jumping and squat-bouncing methods resulted in sufficient compressions most of the time; however, chest recoil and injuries are concerns.

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Abstract 17334: The Detrimental Effect of Chest Compression Interruptions on Coronary Perfusion Pressure Dynamics

Circulation ◽

10.1161/circ.132.suppl_3.17334 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Norman A Paradis ◽

Karen L Moodie ◽

Christopher L Kaufman ◽

Joshua W Lampe

Keyword(s):

Blood Flow ◽

Chest Compression ◽

Detrimental Effect ◽

Perfusion Pressure ◽

Vena Cava ◽

Coronary Perfusion Pressure ◽

Right Atrial ◽

Coronary Perfusion ◽

Chest Compressions ◽

Over Time

Introduction: Guidelines for treatment of cardiac arrest recommend minimizing interruptions in chest compressions based on research indicating that interruptions compromise coronary perfusion pressure (CPP) and blood flow and reducing the likelihood of successful defibrillation. We investigated the dynamics of CPP before, during, and after compression interruptions and how they change over time. Methods: CPR was performed on domestic swine (~30 Kg) using standard physiological monitoring. Blood flow was measured in the abdominal aorta (AAo), the inferior vena cava, the right common carotid and external jugular. Ventricular fibrillation (VF) was electrically induced. Mechanical chest compressions (CC) were started after four minutes of VF. CC were delivered at a rate of 100 compressions per minute (cpm) and at a depth of 2” for a total of 12 min. CPP was calculated as the difference between aortic and right atrial pressure at end-diastole per Utstein guidelines. CPP was determined for 5 compressions prior to the interruption, every 2 seconds during the CC interruption, and for 7 compressions after the interruption. Per protocol, 12 interruptions occurred at randomized time points. Results: Across 12 minutes of CPR, averaged CPP prior to interruption was significantly greater than the averaged CPP after the interruption (22.4±1.0 vs. 15.5±0.73 mmHg). As CPR continued throughout the 12 minutes, CPP during compressions decreased (First 6 min = 24.1±1.4 vs. Last 6 min = 20.1±1.3 mmHg, p=0.05), but the effect of interruptions remained constant resulting in a 20% drop in CPP for every 2 seconds irrespective of the prior CPP. The increase (slope) of CPP after resumption of compressions was significantly reduced over time (First 6 min = 1.47±0.18 vs. Last 6 min = 0.82±0.13 mmHg/compression). Conclusions: Chest compression interruptions have a detrimental effect on coronary perfusion and blood flow. The magnitude of this effect increases over time as a resuscitation effort continues. These data confirm the importance of providing uninterrupted CPR particularly in long duration resuscitations.

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Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human

BMJ Open ◽

10.1136/bmjopen-2020-042062 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042062

Author(s):

Manuel Obermaier ◽

Johannes B Zimmermann ◽

Erik Popp ◽

Markus A Weigand ◽

Sebastian Weiterer ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Meta Analysis ◽

Bibliographic Databases ◽

Chest Compressions ◽

Term Survival ◽

Statistical Heterogeneity ◽

Mechanical Cpr

IntroductionCardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest.Methods and analysisA sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I2-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Ethics and disseminationNo ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences.PROSPERO registration numberCRD42017051633.

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Cardiopulmonary Resuscitation With Mechanical Chest Compression Device During Percutaneous Coronary Intervention. A Case Report

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.614493 ◽

2021 ◽

Vol 8 ◽

Author(s):

Dóra Ujvárosy ◽

Veronika Sebestyén ◽

Tamás Ötvös ◽

Balázs Ratku ◽

István Lorincz ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Coronary Intervention ◽

Chest Compressions ◽

Compression Device ◽

Mechanical Chest Compression ◽

Percutaneous Coronary

Sudden cardiac death is a leading cause of death worldwide, whereby myocardial infarction is considered the most frequent underlying condition. Percutaneous coronary intervention (PCI) is an important component of post-resuscitation care, while uninterrupted high-quality chest compressions are key determinants in cardiopulmonary resuscitation (CPR). In our paper, we evaluate a case of a female patient who suffered aborted cardiac arrest due to myocardial infarction. The ambulance crew providing prehospital care for sudden cardiac arrest used a mechanical chest compression device during advanced CPR, which enabled them to deliver ongoing resuscitation during transfer to the PCI laboratory located 20 km away from the scene. Mechanical chest compressions were continued during the primary coronary intervention. The resuscitation, carried out for 2 h and 35 min, and the coronary intervention were successful, as evidenced by the return of spontaneous circulation and by the fact that, after a short rehabilitation, the patient was discharged home with a favorable neurological outcome. Our case can serve as an example for the effective and safe use of a mechanical compression device during primary coronary intervention.

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Chest compression with 2-DOF parallel manipulator for cardiopulmonary resuscitation

International Journal of Engineering & Technology ◽

10.14419/ijet.v7i2.8.10411 ◽

2018 ◽

Vol 7 (2.8) ◽

pp. 211

Author(s):

G Yedukondalu ◽

Sajjan Patnaik ◽

P Lakshmi Venkatesh ◽

S Siva Jagadeesh

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Kinematic Analysis ◽

Parallel Manipulator ◽

Chest Compressions ◽

Compression Process ◽

Compression Depth ◽

Physical Constraints ◽

Emergency Situations

Chest compression process is used for recovering patients who met with a cardiac arrest in emergency situations. Chest compression is the only possibility of rescuing patients during cardiopulmonary resuscitation (CPR). It is hard to achieve the exact chest compression’s depth and rate even by experienced professionals as per the CPR guideline. A 2-DOF 2-RRR translational parallel manipulator was designed for delivering chest compressions. The kinematic analysis is carried out analytically.The workspace of the manipulator is examined in consideration of physical constraints imposed by joints. Finally, the manipulator operates with exact compression depth and rate during CPR.

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Abstract 32: Chest Compression Fraction Increased When Police Used AED That Analyses Heart Rhythm During CPR

Circulation ◽

10.1161/circ.140.suppl_2.32 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Corina de Graaf ◽

Stefanie G Beesems ◽

Ronald E Stickney ◽

Fred W Chapman ◽

Rudolph W Koster

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Heart Rhythm ◽

Chest Compressions ◽

Automated External Defibrillators ◽

Ecg Analysis ◽

Conventional Analysis

Introduction: Conventional automated external defibrillators (AED) prompt rescuers to stop cardiopulmonary resuscitation (CPR) for ECG analysis during cardiac arrest (CA), but pauses in CPR are associated with worse outcome. A new AED algorithm, cprINSIGHT™ Analysis Technology, analyses the ECG while rescuers continue chest compressions. Hypothesis: Compared to conventional AEDs, AEDs with the cprINSIGHT algorithm will lead to fewer and shorter interruptions of chest compressions for ECG analysis and, thereby, a higher chest compression fraction (CCF). Methods: Amsterdam Police used conventional AEDs in 2016 (LIFEPAK® 1000 defibrillator) and AEDs with cprINSIGHT in 2018 (LIFEPAK CR2 AED); in the CR2 AED, cprINSIGHT is activated after the first conventional analysis. We analysed AED data from control CA cases in 2016 and intervention CA cases in 2018, comparing pre-shock pause, median CCF and CCF categories. CCF was defined as the proportion of time with chest compressions in the period from the start of CPR after analysis 1 to the start of CPR after analysis 2. The CCF analysis included only cases where CPR was provided with a ratio of 30 compressions to 2 ventilations. Results: Data from 111 control and 87 intervention cases were analysed. The initial recorded rhythm was shockable in 42 control cases (38%) and 36 intervention cases (41%). Rhythm during analysis 2 was shockable in 28/103 (27%) control and 19/80 (24%) intervention cases; 15 cases had no second analysis. In 67/80 (84%) intervention cases, analysis 2 reached a decision without prompting for a CPR pause. Intervention cases had a significantly shorter pre-shock pause than control cases (7 sec vs 22 sec, p < 0.001) and significantly higher median CCF (87% vs 77%, P<0.001). CCF was ≥90% in 38% of intervention cases and 10% of control cases (figure). Conclusion: The use of the cprINSIGHT algorithm in AEDs leads to a shorter pre-shock pause, fewer analysis pauses and an increase in CCF compared to conventional AEDs.

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Abstract 17534: The Most Appropriate Number of Personnel Needed for Chest Compressions for In-hospital Cardiac Arrest: A Randomized, Crossover Manikin Study

Circulation ◽

10.1161/circ.132.suppl_3.17534 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Shunsuke Yamanaka ◽

Kei Nishiyama ◽

Hiroyuki Hayashi ◽

Ji Young Huh

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Healthcare Providers ◽

Preliminary Evaluation ◽

Chest Compressions ◽

Rescue Team ◽

Manikin Study ◽

Hospital Cardiac Arrest

Background: Effective chest compression (CC) is vital in cardiopulmonary resuscitation (CPR), and rescuer’s fatigue negatively affects quality of CPR. However, there is no consensus on the appropriate number of personnel needed for CC to avoid rescuer’s fatigue. Objective: We determined the appropriate number of personnel needed for 30-min CPR in a rescue-team in a hospital. Methods: We conducted a preliminary randomized, crossover, manikin trial on healthcare providers. We divided them into Groups A to D according to the intervals between the 2-min CC and assigned a different interval to each group. Groups A, B, C, and D performed CCs at 2-, 4-, 6-, and 8-min intervals as in 2, 3, 4, and 5 personnel, respectively. All participants performed CCs for 30 min with different intervals depending on the assigned group; participants allocated to Groups A, B, C, and D performed 8, 5, 4, and 3 cycles, respectively. We compared the differences between first cycle and the second to the last cycle Results: We enrolled 42 participants (age: 25.2±4.2, men 47.6%) for the preliminary evaluation. We used Kruskal-Wallis for the analysis. Participants in the less interval Groups A and B performed faster (A: -24.28±15.18, B: -7.90±13.49, C: -11.27±17.01, D: -2.38±3.31, P=0.03) and shallower CCs (A: -4.42±6.92, B: -3.18±5.43, C: -0.18±5.74, D: -1.23±4.10, P=0.62). Women-rescuers performed faster (A: -27.25±12.23, B: -7.00±13.97, C: -8.16±19.26, D: 3.16±4.66, P= 0.05) and shallower CCs (A: -6.25±7.54, B: -3.00±6.89, C: -3.66±3.32, D: -0.16±4.35, P=0.58). However, CCs of men-rescuers were not faster (A: -20.33±20.65, B: -9.00±14.44, C: -15.00±15.11, D: -7.14±16.70, P= 0.60) or shallower (A: -2.00±6.55 B: -3.40±3.78, C: 4.00±5.33, D: -2.14±3.98, P=0.06). Conclusion: At least four rescuers (Group C) may be needed to reduce rescuer’s fatigue for 30-min CPR. If the team only includes women, more personnel would be needed as women experience fatigue faster.

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Bag-Valve-Mask versus Laryngeal Mask Airway Ventilation in Cardiopulmonary Resuscitation with Continuous Compressions: A Simulation Study

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000054 ◽

2021 ◽

pp. 1-6

Author(s):

Zerrin Defne Dundar ◽

Mustafa Kursat Ayranci ◽

Sedat Kocak ◽

Abdullah Sadik Girisgin

Keyword(s):

Cardiac Arrest ◽

Laryngeal Mask Airway ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Simulation Study ◽

Laryngeal Mask ◽

Chest Compressions ◽

Study Objective ◽

Volume Limit ◽

The Mean

Abstract Introduction: The 2017 International Liaison Committee on Resuscitation (ILCOR) guideline recommends that Emergency Medical Service (EMS) providers can perform cardiopulmonary resuscitation (CPR) with synchronous or asynchronous ventilation until an advanced airway has been placed. In the current literature, limited data on CPR performed with continuous compressions and asynchronous ventilation with bag-valve-mask (BVM) are available. Study Objective: In this study, researchers aimed to compare the effectiveness of asynchronous BVM and laryngeal mask airway (LMA) ventilation during CPR with continuous chest compressions. Methods: Emergency medicine residents and interns were included in the study. The participants were randomly assigned to resuscitation teams with two rescuers. The cross-over simulation study was conducted on two CPR scenarios: asynchronous ventilation via BVM during a continuous chest compression and asynchronous ventilation via LMA during a continuous chest compression in cardiac arrest patient with asystole. The primary endpoints were the ventilation-related measurements. Results: A total of 92 volunteers were included in the study and 46 CPRs were performed in each group. The mean rate of ventilations of the LMA group was significantly higher than that of the BVM group (13.7 [11.7-15.7] versus 8.9 [7.5-10.3] breaths/minute; P <.001). The mean volume of ventilations of the LMA group was significantly higher than that of the BVM group (358.4 [342.3-374.4] ml versus 321.5 [303.9-339.0] ml; P = .002). The mean minute ventilation volume of the LMA group was significantly higher than that of the BVM group (4.88 [4.15-5.61] versus 2.99 [2.41-3.57] L/minute; P <.001). Ventilations exceeding the maximum volume limit occurred in two (4.3%) CPRs in the BVM group and in 11 (23.9%) CPRs in the LMA group (P = .008). Conclusion: The results of this study show that asynchronous BVM ventilation with continuous chest compressions is a reliable and effective strategy during CPR under simulation conditions. The clinical impact of these findings in actual cardiac arrest patients should be evaluated with further studies at real-life scenes.

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