Maximizing cardiopulmonary resuscitation in patients with intra-aortic balloon pumps

Improved hemodynamics and blood flow have been reported in patients with IABPs who experience cardiopulmonary arrest and require CPR. The following research questions, however, remain unanswered: Is there a more effective method of using IABP to prevent cardiac arrest and the need for CPR? Is the timing of balloon inflation and deflation the same for patients undergoing CPR as it is for patients who do not require CPR? Would earlier or later inflation or deflation further enhance cerebral or systemic blood flow? What are the most effective ways for healthcare staff to maintain competency skills in CPR in patients with IABPs?

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Forward blood ﬂow provoked by changing intravascular pressure using an extracorporeal circulation during cardiopulmonary resuscitation

10.22514/sv.2020.16.0082 ◽

2020 ◽

Keyword(s):

Blood Flow ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Intrathoracic Pressure ◽

Arterial Blood Flow ◽

Systemic Blood ◽

Systemic Blood Flow ◽

Closed Chest ◽

Arterial Blood ◽

Intravascular Pressure

Since both “cardiac pump” and “thoracic pump” theories have been proved during cardiopulmonary resuscitation (CPR), the mechanism of forward blood flow during closed chest compression still remains open to question. The cardiac pump seems to work by the direct compression of the cardiac ventricles between the sternum and vertebral column. A pressure gradient created between the ventricle and aorta generates systemic blood flow. However, the thoracic pump mechanism presumes chest compression causes a rise in intrathoracic pressure which generates a blood flow from the thoracic cavity to the systemic circulation. Retrograde blood flow from the right heart into the systemic veins is prevented by a concomitant collapse of veins at the thoracic inlet. We hypothesize that the intrinsic decrease of vascular resistance from the aorta to peripheral arteries and the existence of competent venous valves enable blood to flow unidirectionally by the fluctuation of intravascular pressures during closed chest compression. The purpose of this study is to prove an antegrade arterial blood flow without cardiac compression and intrathoracic pressure changes in an animal cardiac arrest model. We demonstrate that arterial pulses can be developed by using an extracorporeal circuit, resulting in forward blood flow from the aorta through the systemic vasculature. It can be suggested that changes in intravascular pressure provoked by either cardiac or thoracic pump generate systemic blood flow during closed chest compression, while systemic vascular patency and valve function may be required for successful CPR.

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Timing of pulmonary and systemic blood flow during intermittent high intrathoracic pressure cardiopulmonary resuscitation in the dog

The American Journal of Cardiology ◽

10.1016/0002-9149(82)90206-5 ◽

1982 ◽

Vol 49 (8) ◽

pp. 1883-1889 ◽

Cited By ~ 30

Author(s):

James M. Cohen ◽

Nisha Chandra ◽

Philip O. Alderson ◽

Andries van Aswegen ◽

Joshua E. Tsitlik ◽

...

Keyword(s):

Blood Flow ◽

Cardiopulmonary Resuscitation ◽

Intrathoracic Pressure ◽

Systemic Blood ◽

Systemic Blood Flow

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Management of hypotension and low systemic blood flow in the very low birth weight neonate during the first postnatal week

Journal of Perinatology ◽

10.1038/sj.jp.7211464 ◽

2006 ◽

Vol 26 (S1) ◽

pp. S8-S13 ◽

Cited By ~ 49

Author(s):

I Seri

Keyword(s):

Blood Flow ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Systemic Blood ◽

Systemic Blood Flow ◽

Birth Weight Neonate

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Does umbilical cord milking result in higher measures of systemic blood flow in preterm infants?

Acta Paediatrica ◽

10.1111/apa.13926 ◽

2017 ◽

Vol 106 (10) ◽

pp. 1709-1709

Author(s):

Leah Yieh ◽

Jamie B. Warren

Keyword(s):

Blood Flow ◽

Preterm Infants ◽

Umbilical Cord ◽

Systemic Blood ◽

Systemic Blood Flow ◽

Umbilical Cord Milking

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Distribution of systemic blood flow during anoxia in the turtle, Chrysemys scripta

Respiration Physiology ◽

10.1016/0034-5687(89)90112-6 ◽

1989 ◽

Vol 78 (3) ◽

pp. 383-389 ◽

Cited By ~ 18

Author(s):

Donald G. Davies

Keyword(s):

Blood Flow ◽

Systemic Blood ◽

Systemic Blood Flow

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Estimation of systemic blood flow by the indicator-dilution technic in the presence of central shunts

The American Journal of Cardiology ◽

10.1016/0002-9149(68)90204-x ◽

1968 ◽

Vol 22 (5) ◽

pp. 672-677 ◽

Cited By ~ 2

Author(s):

Paul J. Friedman ◽

S.Evans Downing

Keyword(s):

Blood Flow ◽

Indicator Dilution ◽

Systemic Blood ◽

Systemic Blood Flow

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Abstract 48: Neurological Outcomes of Inpatient Cardiopulmonary Resuscitation in a University Hospital

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a48 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Lia M Thomas ◽

Miguel Benavides ◽

Pierre Kory ◽

Samuel Acquah ◽

Steven Bergmann

Keyword(s):

Cardiac Arrest ◽

Critical Care ◽

Cardiopulmonary Resuscitation ◽

Therapeutic Hypothermia ◽

Cardiopulmonary Arrest ◽

University Hospital ◽

Neurological Dysfunction ◽

Neurological Outcomes ◽

Shockable Rhythm ◽

Neurologically Intact

Background: Despite advances in out- of- hospital resuscitation practices, the prognosis of most patients after a cardiac arrest remains poor. The long term outcomes of patients successfully resuscitated from cardiac arrest are often complicated by neurological dysfunction. Therapeutic hypothermia has significantly improved neurological outcomes in patients successfully resuscitated from out- of- hospital cardiac arrests. The objective of this study was to look into the neurological outcomes in inpatients after successful cardiopulmonary resuscitation (CPR) in a university hospital setting. Methods: This was a retrospective observational study of 68 adult patients who experienced cardiac or respiratory arrest over an 18 month period at a metropolitan teaching hospital with dedicated, trained code teams. Arrests that occurred in the Emergency Department, Critical Care Units or Operating Rooms were excluded. Results: Of the 68 consecutive patients included in this study, 53% were resuscitated successfully. However, only 12 (18%) survived to discharge from the hospital and only 6 (10%) were discharged with intact neurological status. The initial survival was better in patients who received prompt CPR and in those with less co - morbidities. Pulseless electrical activity (PEA) or asystole were the most common rhythms (47% of the arrests). Most patients who survived and were neurologically intact had PEA (67%). We believe that most PEA arrests were more likely severe hypotension with the inability to palpate a pulse rather than true PEA. The mean time to defibrillation for all patients with an initial shockable rhythm (n=5) was 8.2 minutes. Patients who had an initial shockable rhythm and survived to discharge were shocked within 1 minute (n=2). Conclusion: Despite advances in critical care, survival from inpatient cardiopulmonary arrest to neurologically intact discharge remains poor. Therapeutic hypothermia should be expanded to those resuscitated from in - hospital cardiopulmonary arrest to determine if neurological outcomes would improve.

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Abstract 114: Effect of Body Position on Intracranial Pressure and Carotid Blood Flow During Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.142.suppl_4.114 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Yaël Levy ◽

Rocio Fernandez ◽

Fanny Lidouren ◽

Matthias Kohlhauer ◽

Lionel Lamhaut ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Arrest ◽

Intracranial Pressure ◽

Cardiopulmonary Resuscitation ◽

Body Position ◽

Spontaneous Circulation ◽

Systemic Hemodynamics ◽

Body Tilt ◽

Whole Body ◽

Extracorporeal Cardiopulmonary Resuscitation

Introduction: Extracorporeal cardiopulmonary resuscitation (E-CPR) using extracorporeal membrane oxygenation (ECMO) is widely proposed for the treatment of refractory cardiac arrest. Hypothesis: Since cerebral autoregulation is altered in such conditions, body position may modify hemodynamics during ECPR. Our goal was to determine whether a whole body tilt-up challenge (TUC) could lower intracranial pressure (ICP) as previously shown with conventional CPR, without deteriorating cerebral blood flow (CBF). Methods: Pigs were anesthetized and instrumented for the continuous evaluation of CBF, ICP and systemic hemodynamics. After 15 min of untreated ventricular fibrillation they were treated with 30 min of E-CPR followed by sequential defibrillation shocks until resumption of spontaneous circulation (ROSC). ECMO was continued after ROSC to target a mean arterial pressure (MAP) >60 mmHg. Animals were maintained in the flat position (FP) throughout protocol, except during a 2 min TUC of the whole body (+30°) at baseline, during E-CPR and after-ROSC. Results: Four animals received the entire procedure and ROSC was obtained in 3/4. After cardiac arrest, E-CPR was delivered at 29±2 ml/kg/min to maintain a MAP of 57±8 mmHg in the FP. CBF was 28% of baseline and ICP remain stable (12±1 vs 13±1 mmHg during ECPR vs baseline, respectively). Under baseline pre-arrest conditions TUC resulted in a significant decrease in ICP (-63±7%) and CBF (-21±3%) versus the FP, with no significant effect on systemic hemodynamics. During E-CPR and after ROSC, TUC markedly reduced ICP but CBF remained unchanged vs the FP (Figure). Conclusion: During E-CPR whole body TUC reduced ICP without lowering CBF compared with E-CPR flat. Additional investigations with prolonged TUC and selective head and thorax elevation during E-CPR are warranted.

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