Effects of manual chest compression and descompression maneuver on lung volumes, capnography and pulse oximetry in patients receiving mechanical ventilation

ABSTRACT Objective: To investigate the effects of manual chest compression (MCC) on the expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure (PEEP-ZEEP) airway clearance maneuver applied in patients on mechanical ventilation. The flow bias, which influences pulmonary secretion removal, is evaluated by the ratio and difference between the peak expiratory flow (PEF) and the peak inspiratory flow (PIF). Methods: This was a crossover randomized study involving 10 patients. The PEEP-ZEEP maneuver was applied at four time points, one without MCC and the other three with MCC, which were performed by three different respiratory therapists. Respiratory mechanics data were obtained with a specific monitor. Results: The PEEP-ZEEP maneuver without MCC was enough to exceed the threshold that is considered necessary to move secretion toward the glottis (PEF − PIF difference > 33 L/min): a mean PEF − PIF difference of 49.1 ± 9.4 L/min was achieved. The mean PEF/PIF ratio achieved was 3.3 ± 0.7. Using MCC with PEEP-ZEEP increased the mean PEF − PIF difference by 6.7 ± 3.4 L/min. We found a moderate correlation between respiratory therapist hand grip strength and the flow bias generated with MCC. No adverse hemodynamic or respiratory effects were found. Conclusions: The PEEP-ZEEP maneuver, without MCC, resulted in an expiratory flow bias superior to that necessary to facilitate pulmonary secretion removal. Combining MCC with the PEEP-ZEEP maneuver increased the expiratory flow bias, which increases the potential of the maneuver to remove secretions.

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Abstract 13721: The Monitoring of rSO2 Value During CPR is Useful for High-Quality CPR

Circulation ◽

10.1161/circ.132.suppl_3.13721 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yoshihito Ogawa ◽

Tadahiko Shiozaki ◽

Tomoya Hirose ◽

Mitsuo Ohnishi ◽

Goro Tajima ◽

...

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Clinical Utility ◽

Spontaneous Circulation ◽

Regional Cerebral Oxygen Saturation ◽

High Quality ◽

Specificity And Sensitivity ◽

Single Center Study ◽

Manual Chest Compression ◽

Hospital Cardiac Arrest

[Background] Recently, the patients with out-of-hospital cardiac arrest are increasing. It is very important to do chest compression continuously for the return of spontaneous circulation (ROSC). But we can not but stop chest compression during checking pulse every few minutes. We reported that Regional cerebral Oxygen Saturation (rSO2) value was not elevated by manual chest compression and mechanical chest compression increased a little rSO2 value on CPR without ROSC and rSO2 value became a good parameter of ROSC in single center study. [Purpose] The purpose of this study is to evaluate clinical utility of rSO2 value during CPR in multicenter study. [Method] Retrospectively, we considered the rSO2 value of the out-of -hospital cardiac arrest patients from December 2012 to December 2014 in multicenter. During CPR, rSO2 were recorded continuously from the forehead of the patients by TOS-OR (Japan). CPR for patients with OHCA was performed according to the JRC-guidelines 2010. [Result] 252 patients with OHCA were included in this study. The rSO2 value on arrival, during CPR and ROSC were 44.4±8.9%, 45.4±9.7%, 58.6±9.2%. In ROSC, with rSO2 cutoff value of 52.7%, the specificity and sensitivity were 80% and 79%, respectively. The negative predict value was 99.2%, respectively. It means little possible to ROSC, if the rSO2 value is less than 52.7%. So, it may be possible to reduce the frequency of checking pulse during CPR. [Conclusion] The monitoring of rSO2 value could reduce the frequency of checking pulse during CPR and do chest compression continuously.

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Abstract 20: Peripheral Intravenous Analysis Detects Return of Spontaneous Circulation Without Interruption of Chest Compressions in a Rat Model of Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.140.suppl_2.20 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Claudius Balzer ◽

Franz J Baudenbacher ◽

Antonio Hernandez ◽

Michele M Salzman ◽

Matthias L Riess ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Venous Pressure ◽

Fold Increase ◽

Spontaneous Circulation ◽

Arterial Line ◽

Chest Compressions ◽

Waveform Data ◽

Return Of Spontaneous Circulation

Introduction: A higher chest compression fraction (CCF) or percentage of time providing chest compressions is associated with improved survival after cardiac arrest (CA). Pauses in chest compression duration during cardiopulmonary resuscitation (CPR) to palpate a pulse can reduce the CCF. Peripheral Intravenous Analysis (PIVA) is a novel method for determining cardiac and volume status using waveforms from a standard peripheral intravenous (IV) line. We hypothesize that PIVA will demonstrate the onset of return of spontaneous circulation (ROSC) without interruption of CPR. Methods: Eight Zucker Diabetic Fatty (ZDF) rats (4 lean, 4 diabetic) were intubated, ventilated, and cannulated with a 24g IV in the tail vein and a 22g IV in the femoral artery, each connected to a TruWave pressure transducer. Mechanical ventilation was discontinued to achieve CA. After 8 minutes, CPR began with mechanical ventilation, IV epinephrine, and chest compressions using 1.5 cm at 200 times per minute until mean arterial pressure (MAP) increased to 120 mmHg per arterial line. All waveforms were recorded and analyzed in LabChart. PIVA was measured using a Fourier transform of the peripheral venous waveform. Data are mean ± SD. Statistics: Unpaired student’s t-test (two-tailed), α = 05. Results: CA and ROSC were achieved in all 8 rats. Within 1 minute of CPR, there was a 70 ± 35 fold increase/decrease in PIVA during CPR that was temporally associated with ROSC. Within 8 ± 13 seconds of a reduction in PIVA, there was a rapid increase in end-tidal CO 2 . In all rats, ROSC occurred within 38 ± 9 seconds of the maximum PIVA value. Peripheral venous pressure decreased by 1.2 ± 0.9 mmHg during resuscitation and ROSC, which was not significant different at p=0.05. Conclusion: In this pilot study, PIVA detected ROSC without interrupting CPR. Use of PIVA may obviate the need pause CPR for pulse checks, and may result in a higher CCF and survival. Future studies will focus on PIVA and CPR efficacy.

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Regional intrapulmonary gas distribution in awake and anesthetized-paralyzed prone man

Journal of Applied Physiology ◽

10.1152/jappl.1978.45.4.528 ◽

1978 ◽

Vol 45 (4) ◽

pp. 528-535 ◽

Cited By ~ 46

Author(s):

K. Rehder ◽

T. J. Knopp ◽

A. D. Sessler

Keyword(s):

Mechanical Ventilation ◽

Vertical Distribution ◽

Vertical Gradient ◽

Phase Iii ◽

Residual Volume ◽

Gas Distribution ◽

Lung Volumes ◽

Regional Lung ◽

Residual Capacity ◽

The Vertical Distribution

The intrapulmonary distribution of inspired gas (ventilation/unit lung volume, VI), functional residual capacity (FRC), closing capacity (CC), and the slope of phase III were determined in five awake and five anesthetized-paralyzed volunteers who were in the prone position with the abdomen unsupported. After induction of anesthesia-paralysis, FRC was less in four of five subjects and CC was consistently less. At FRC there was no difference in the vertical gradient of regional lung volumes between the awake and anesthetized-paralyzed prone subjects. Also, there was no difference in VI between the two states. The normalized slope of phase III decreased consistently with induction of anesthesia-paralysis, but the vertical distribution of a 133Xe bolus inhaled from residual volume was not different between the two states. The data of the study are compatible with 1) a pattern of expansion of the respiratory system during anesthesia-paralysis and mechanical ventilation different than that during spontaneous breathing and 2) a more uniform intraregional distribution of inspired gas and/or a different sequence of emptying during anesthesia-paralysis.

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Defibrillation delivered during the upstroke phase of manual chest compression improves shock success*

Critical Care Medicine ◽

10.1097/ccm.0b013e3181cc4944 ◽

2010 ◽

Vol 38 (3) ◽

pp. 910-915 ◽

Cited By ~ 12

Author(s):

Yongqin Li ◽

Hao Wang ◽

Jun Hwi Cho ◽

Weilun Quan ◽

Gary Freeman ◽

...

Keyword(s):

Chest Compression ◽

Manual Chest Compression

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Leg-heel chest compression as an alternative for medical professionals in times of COVID-19

10.1101/2021.03.09.21253220 ◽

2021 ◽

Author(s):

Matthias Ott ◽

Alexander Krohn ◽

Laurence H. Bilfield ◽

F. Dengler ◽

C. Jaki ◽

...

Keyword(s):

Chest Compression ◽

Effective Alternative ◽

Medical Professionals ◽

Compression Rate ◽

Compression Depth ◽

Significant Difference ◽

Manual Chest Compression ◽

Special Circumstances ◽

Previous Training

AbstractObjectiveTo evaluate leg-heel chest compression without previous training as an alternative for medical professionals and its effects on distance to potential aerosol spread during chest compression.Methods20 medical professionals performed standard manual chest compression followed by leg-heel chest compression after a brief instruction on a manikin. We compared percentage of correct chest compression position, percentage of full chest recoil, percentage of correct compression depth, average compression depth, percentage of correct compression rate and average compression rate between both methods. In a second approach, potential aerosol spread during chest compression was visualized.ResultsThere was no significant difference between manual and leg-heel compression. The distance to potential aerosol spread could have been increased by leg-heel method.ConclusionUnder special circumstances like COVID-19-pandemic, leg-heel chest compression may be an effective alternative without previous training compared to manual chest compression while markedly increasing the distance to the patient.

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Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

The American Surgeon ◽

10.1177/00031348211047507 ◽

2021 ◽

pp. 000313482110475

Author(s):

Magnus J. Chun ◽

Yichi Zhang ◽

Eman A. Toraih ◽

Patrick R. McGrew

Keyword(s):

Systematic Review ◽

Chest Compression ◽

Meta Analysis ◽

Sternal Fracture ◽

Iatrogenic Injuries ◽

Mechanical Chest Compression ◽

Manual Chest Compression ◽

Significant Life ◽

Life Threatening ◽

Meta Analyses

Purpose Mechanical chest compression has been shown to be equivalent to manual chest compression in providing survival benefits to patients experiencing cardiac arrest. There has been a growing need for a contemporary review of iatrogenic injuries caused by mechanical in comparison with manual chest compression. Our study aims to analyze the studies that document significant life-threatening iatrogenic injuries caused by mechanical and manual chest compression. Methods A systematic review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. All studies published after January 1st, 2000 were reviewed using inclusion/exclusion criteria and completed by May 2020. A total of 7202 patients enrolled in 15 studies were included in our meta-analysis. Results Significant life-threatening iatrogenic injuries had higher odds of occurring when mechanical chest compression was used compared to manual chest compression, especially for hemothorax and liver lacerations. Mechanical chest compression involves consistently deeper compression depths compared to manual chest compression, potentially resulting in more injuries. In the mechanical chest compression cohort, chest wall fractures had the highest incidence rate (55.7%), followed by sternal fracture (28.3%), lung injuries (3.7%), liver (1.0%), and diaphragm (.2%) lacerations. Conclusions Mechanical chest compression was associated with more iatrogenic injuries as compared to manual chest compression. Further research is needed to define the appropriate application of mechanical in comparison with manual chest compression in different scenarios. Levels of provider training, different mechanical chest compression device types, patient demographics, and compression duration/depth may all play roles in influencing outcomes.

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