Developing a kinematic understanding of chest compressions: the impact of depth and release time on blood flow during cardiopulmonary resuscitation

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

Circulation ◽

10.1161/circ.116.suppl_16.ii_938 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Yasumasa Oode ◽

Kentarou Shimizu ◽

Asako Matsushima ◽

Kentarou Kajino ◽

Yuukou Nakagawa ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Contrast Medium ◽

Chest Compression ◽

Femoral Vein ◽

Vena Cava ◽

Hepatic Veins ◽

Chest Compressions ◽

Portal Veins

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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Increased cortical cerebral blood flow with LUCAS; a new device for mechanical chest compressions compared to standard external compressions during experimental cardiopulmonary resuscitation

Resuscitation ◽

10.1016/j.resuscitation.2004.12.006 ◽

2005 ◽

Vol 65 (3) ◽

pp. 357-363 ◽

Cited By ~ 128

Author(s):

Sten Rubertsson ◽

Rolf Karlsten

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Cardiopulmonary Resuscitation ◽

Chest Compressions ◽

New Device ◽

Cortical Cerebral Blood Flow

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The impact of ultrasonography on quality of cardiopulmonary resuscitation: a retrospective observational study

10.21203/rs.2.19577/v1 ◽

2019 ◽

Author(s):

Wan-Ching Lien ◽

Kah-Meng Chong ◽

Herman Chih-Heng Chang ◽

Su-Fen Cheng ◽

Wei-Tien Chang ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Observational Study ◽

Pause Duration ◽

University Hospital ◽

Retrospective Observational Study ◽

Secondary Outcome ◽

Chest Compressions ◽

Traumatic Cardiac Arrest ◽

The Impact

Abstract Background: This study aims to evaluate the effect of ultrasonography (US) on quality of cardiopulmonary resuscitation (CPR), and US-related pause duration of pulse-checks.Methods: This retrospective observational study was conducted at the emergency department of National Taiwan University Hospital between April 2017 and May 2018. Video recordings for adult patients with non-traumatic cardiac arrest in designated resuscitation rooms were collected. The primary outcome was chest compression fraction (CCF) in the CPR with US group. The secondary outcome was pause duration of pulse checks with introduction of US or not. US-related pulse-checks were stratified into US during hands-off periods only (hands-off US), and US performing from hands-off to hands-on periods (continuous US). Results: A total of 153 patients were enrolled. Continuous US was performed in 116 patients. CCF was similar (92%) between the CPR with and without US groups. In the CPR with US group, pause duration was significantly longer in US-related pulse-checks than that without US (9.3±8.0 v.s. 7.3±4.7s, p<0.0001). Notably, longer pause was noted in the hands-off US, as comparing with that in the continuous US (18.3±16.4 v.s. 7.7±3.5s, p<0.0001). Conclusions: The introduction of US during CPR did not impact on CCF. Individual pause would not be lengthened if continuous US was performed while allowing chest compressions to be resumed. In addition, structured training, adequate facilities and manpower, and a timer reminding resumption of chest compressions would help sophisticated integration of US into CPR process.

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Advantages of Open Chest Cardiopulmonary Resuscitation (OCCPR)

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00044587 ◽

1985 ◽

Vol 1 (S1) ◽

pp. 230-232

Author(s):

Nicholas G. Bircher ◽

Peter Safar

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Cardiopulmonary Resuscitation ◽

Cardiac Massage ◽

Chest Compressions ◽

Eeg Activity ◽

Open Chest ◽

The Brain

Introduction: Although the hemodynamic superiority of open chest cardiopulmonary resuscitation has long been recognized, its advantages with respect to the brain have only recently been investigated. Yashon demonstrated the ability of open chest CPR to maintain EEG activity during prolonged resuscitation. Alifimoff showed improved cerebral reco-very in dogs after open chest CPR. Byrne has demonstrated that internal cardiac massage can provide nearly normal cerebral blood flow in dogs as opposed to the 30% of normal seen during standard CPR, which consists of 60 chest compressions per min with a ventilation interposed after every fifth compression and 50% compression duration.

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