Intrathoracic Pressure Regulator During Continuous-Chest-Compression Advanced Cardiac Resuscitation Improves Vital Organ Perfusion Pressures in a Porcine Model of Cardiac Arrest

Background: Current guidelines recommend that chest compressions for children be done at either 1.5 inches depth and 100 per minute, or one-third the chest A-P diameter depth and 100 per minute. Neither of these recommendations is based on scientific evidence. Objective: As part of an ongoing efficacy trial, we sought to compare the safety of three different chest compression strategies in a porcine model of pediatric cardiac arrest. Methods: Following anesthesia, instrumentation, and induction of asphyxial cardiac arrest, we randomly assigned 48 domestic swine to one of three groups (n=16 per group). The mean mass of 25.7 kg approximates the 50 th percentile for a 7 year old. Group 1 had fixed chest compression depth of 1.5 inches/rate 100; group 2 had fixed proportional depth of one-third the A-P diameter/rate 100; group 3 used an adaptive algorithm that incrementally increased chest compression rate and/or depth from baseline 1.5in (max: 2.13in) and 100/min (max; 130/min) every 25s while coronary perfusion pressure was below 25mmHg. Necropsies were independently performed by a veterinarian and veterinary technologist who were blinded to group assignment. The primary safety outcome was unrecoverable injury (i.e. toxicity), which we defined as either a total lung injury score ≥16 (score can range from 0 to 20) plus presence of hemothorax, or disruption of either the aorta or vena cava. Data were analyzed with the Bayesian Beta Binomial to determine if within-group toxicity exceeded an unacceptable level (30%) with a pre-selected posterior predictive threshold of 0.75(ptox). Lung injury scores between groups were compared with Kruskal-Wallis tests. Results: Median total lung injury scores were: 12 for group 1; 18 for group 2; 14 for group 3. Group 2 was significantly different from both groups 1 and 3 (p<0.001). Groups 1 and 3 did not differ (p=0.24). Toxicity occurred in zero animals in group 1 (ptox=0.0001); 7 animals in group 2 (ptox=0.8180); and 1 animal in group 3 (ptox=0.0076). The posterior probability threshold was exceeded in group 2 which warranted termination of the treatment arm for safety. Conclusions: Chest compressions performed at a depth of one-third the A-P diameter are unsafe. The safety of this approach in children should be carefully evaluated.

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NOVEL DEVICE IMPROVES HEMODYNAMICS AND VITAL ORGAN PERFUSION PRESSURES DURING HYPOVOLEMIC CARDIAC ARREST IN PIGS

Critical Care Medicine ◽

10.1097/00003246-200412001-00207 ◽

2004 ◽

Vol 32 (Supplement) ◽

pp. A56

Author(s):

Demetris Yannopoulos ◽

Scott McKnite ◽

Keith G Lurie

Keyword(s):

Cardiac Arrest ◽

Vital Organ ◽

Organ Perfusion ◽

Novel Device

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Adjunct terlipressin effect on vital organ perfusion during advanced life support in a porcine model of ventricular fibrillation

Critical Care ◽

10.1186/cc7348 ◽

2009 ◽

Vol 13 (Suppl 1) ◽

pp. P184

Author(s):

A Truhlar ◽

V Cerny ◽

Z Turek ◽

D Kodejskova ◽

J Suchankova

Keyword(s):

Ventricular Fibrillation ◽

Porcine Model ◽

Life Support ◽

Advanced Life Support ◽

Vital Organ ◽

Organ Perfusion

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Improved cerebral perfusion pressures and 24-hr neurological survival in a porcine model of cardiac arrest with active compression-decompression cardiopulmonary resuscitation and augmentation of negative intrathoracic pressure*

Critical Care Medicine ◽

10.1097/ccm.0b013e318246b9ad ◽

2012 ◽

Vol 40 (6) ◽

pp. 1851-1856 ◽

Cited By ~ 38

Author(s):

Anja K. Metzger ◽

Margot Herman ◽

Scott McKnite ◽

Wanchun Tang ◽

Demetris Yannopoulos

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Perfusion ◽

Porcine Model ◽

Intrathoracic Pressure ◽

Negative Intrathoracic Pressure

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Abstract 358: Three-Sided Chest Compression is Beneficial to Rats Suffering From Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.358 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Yu Okuma ◽

Koichiro Shinozaki ◽

Tsukasa Yagi ◽

Kota Saeki ◽

Tai Yin ◽

...

Keyword(s):

Cardiac Arrest ◽

Arterial Pressure ◽

Cardiac Function ◽

Chest Compression ◽

Cerebral Oxygenation ◽

Intrathoracic Pressure ◽

Spontaneous Circulation ◽

Left Ventricular ◽

Sprague Dawley ◽

Targeted Interventions

Objective: Rat models are necessary to study targeted interventions to improve survivability in patients suffered from a cardiac arrest (CA). For translational researchers, increasing the rate of return of spontaneous circulation (ROSC) is important to reduce the number of rats being used to obtain sufficient data. Yet, few studies have demonstrated how to perform better chest compression on rats. Methods: Rats underwent 10 min of asphyxia to induce CA. All rats were placed in a supine position. Three types of chest compression were examined: 1-sided method (classic) with 2 fingers on the sternum; 2-sided method with 2 fingers on the chest from both sides; and the 3-sided method with 2 hands (2 fingers on the sternum and with 2 fingers on the chest). ROSC rates, cardiac function, arterial pressure(s), intrathoracic pressure, cerebral oxygenation, and end-tidal CO 2 (EtCO 2 ) were measured. In addition, survival after 14-min asphyxia was assessed. Results: Male Sprague-Dawley rats were used and there were no differences in chest compression rates among the three groups. The ROSC rate was 100% (8/8) with the 3-sided method, 80% (4/5) with the 1-sided method, and 60% (3/5) with the 2-sided method. The 3-sided group showed significantly shorter time to ROSC (105.0±36.0 sec for the 1-sided method vs.141.0±21.7 sec for the 2-sided method vs. 57.8±12.3 sec for the 3-sided method, p<.05). The 3-sided method significantly increased the left ventricular stroke volume (the ratio of baseline: 1.2±0.6, 1.3±0.1, vs. 2.1±0.6, p<.05) and pressure (24.0±5.5, 19.8±3.4, vs. 29.4±1.8 mmHg, p<.05), the difference of common carotid arterial pressure to femoral artery pressure (4.0±2.5, 0.3±1.6, vs. 8.4±2.6 mmHg, p<.01), intrathoracic pressure (esophagus: 7.6±1.9, 7.3±2.8, vs. 12.7±2.2 mmHg, p<.01), cerebral oxygenation (the ratio of baseline: 1.4±0.1, 1.3±0.2, vs. 1.6±0.04, p<.05) and EtCO 2 (the ratio of baseline: 12.4±2.0, 14.2±1.9, vs. 17.5±1.7 mmHg, p<.05). The 3-sided chest compression achieved 75% (3/4) ROSC from 14-min asphyxia CA. Conclusions: The 3-sided chest compression was associated with the most successful ROSC. It is likely that the 3-sided method increased intrathoracic pressure and stabilized cardiac function, which might be beneficial to the brain.

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