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