A Preliminary Study of Cardiopulmonary Resuscitation by Circumferential Compression of the Chest with Use of a Pneumatic Vest

Halperin, Henry R.; Tsitlik, Joshua E.; Gelfand, M.; Weisfeldt, Myron L.; Gruben, Kreg G.; Levin, Howard R.; Rayburn, Barry K.; Chandra, Nisha; Scott, Carol; Kreps, Billie J.; Siu, Cynthia; Guerci, Alan D.

doi:10.1056/nejm199309093291104

Cited by 191 publications

(70 citation statements)

References 24 publications

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“…25 These devices have the potential to generate better hemodynamic characteristics than manual chest compressions. 26 Nevertheless, they have remained unpopular in the clinical arena because they are often cumbersome to use and awkward to work around if other patient instrumentation is required. The other solution is to improve monitoring and feedback to reduce human error during manual CPR.…”

Section: Discussionmentioning

confidence: 99%

Chest Compression Rates During Cardiopulmonary Resuscitation Are Suboptimal

et al. 2005

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Background-Recent data highlight a vital link between well-performed cardiopulmonary resuscitation (CPR) and survival after cardiac arrest; however, the quality of CPR as actually performed by trained healthcare providers is largely unknown. We sought to measure in-hospital chest compression rates and to determine compliance with published international guidelines. Methods and Results-We developed and validated a handheld recording device to measure chest compression rate as a surrogate for CPR quality. A prospective observational study of adult cardiac arrests was performed at 3 hospitals from April 2002 to October 2003. Resuscitations were witnessed by trained observers using a customized personal digital assistant programmed to store the exact time of each chest compression, allowing offline calculation of compression rates at serial time points. In 97 arrests, data from 813 minutes during which chest compressions were delivered were analyzed in 30-second time segments. In 36.9% of the total number of segments, compression rates were Ͻ80 compressions per minute (cpm), and 21.7% had rates Ͻ70 cpm. Higher chest compression rates were significantly correlated with initial return of spontaneous circulation (mean chest compression rates for initial survivors and nonsurvivors, 90Ϯ17 and 79Ϯ18 cpm, respectively; Pϭ0.0033). Conclusions-In-hospital chest compression rates were below published resuscitation recommendations, and suboptimal compression rates in our study correlated with poor return of spontaneous circulation. CPR quality is likely a critical determinant of survival after cardiac arrest, suggesting the need for routine measurement, monitoring, and feedback systems during actual resuscitation. (Circulation. 2005;111:428-434.)

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Section: Discussionmentioning

confidence: 99%

Chest Compression Rates During Cardiopulmonary Resuscitation Are Suboptimal

et al. 2005

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“…Three decades after Kouwenhoven's initial reports, researchers also at the Johns Hopkins Medical School proposed an alternative theory of forward blood flow during resuscitation efforts for cardiac arrest 4. They proposed that chest compressions for primary cardiac arrest caused a rise in the intrathoracic pressure, which is transmitted to the intrathoracic vascular, producing forward blood flow 4.…”

Section: Discussionmentioning

confidence: 99%

“…They proposed that chest compressions for primary cardiac arrest caused a rise in the intrathoracic pressure, which is transmitted to the intrathoracic vascular, producing forward blood flow 4. These academic resuscitation researchers proposed that with each chest compression the intrathoracic pressure rises because of the collapse of the airways; the thoracic pump theory.…”

Section: Discussionmentioning

confidence: 99%

“…These academic resuscitation researchers proposed that with each chest compression the intrathoracic pressure rises because of the collapse of the airways; the thoracic pump theory. This theory presumes that the rise in the intrathoracic pressures results in collapse of the pulmonary airways, thereby reducing the movement of air out of the lungs and reducing the size of the intrathoracic structures, but not necessary equally 4. The collapse of venous structures at the thoracic inlet was postulated to prevent retrograde venous blood flow and with each relaxation of chest compressions, the intrathoracic pressure falls with return of venous blood 2, 4…”

Section: Discussionmentioning

confidence: 99%

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The mechanism of blood flow during chest compressions for cardiac arrest is probably influenced by the patient's chest configuration

Ewy

2018

Acute Medicine & Surgery

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AimMechanical assist devices are sometimes needed during resuscitation efforts of patients with prolonged cardiac arrest. Two such devices, the AutoPulse and the LUCAS, have different mechanisms of action. We propose that the effectiveness of mechanical assist devices is somewhat dependent on the configuration and compliance of the patient's chest wall.MethodsA previous study of patients with out‐of‐hospital cardiac arrest in Arizona reported that survivors were younger and many were observed to have narrow anterior–posterior chest diameters. These observations suggest that the predominant mechanism of blood flow during cardiopulmonary resuscitation of individuals with primary cardiac arrest is influenced by the patient's anterior–posterior chest diameter and compliance. It is proposed that in older individuals with an increased anterior–posterior chest diameter and decreased chest compliance that the AutoPulse, which works by increasing intrathoracic pressures, may be more effective. In contrast, the LUCAS device, which works predominately by compression of the sternum, is probably more effective in patients with narrower anterior–posterior diameters and a more compliant chest.ResultsThese hypotheses need to be confirmed by researchers who not only have access to the lateral chest roentgenograms of patients with cardiac arrest, to determine their anterior–posterior chest diameter, but also to the type of mechanical device that was used during resuscitation efforts and their patient's survival. If the observations herein proposed are confirmed, hospitals and paramedics may ideally need to have one of each type of mechanical chest compression unit and select the one to use depending on the patient's age and anterior–posterior chest diameter.ConclusionsThe mechanism of blood flow in patients with cardiac arrest is predominantly secondary to cardiac compression in younger patients with narrow anterior chest diameters and predominately secondary to the thoracic pump mechanism in older patients with emphysema.

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“…Investigators have tested various compression forces, rates, and duty cycles, investigated interposed chest and abdominal compressions, and proposed rhythmic abdominal compressions only (Maier et al 1984;Criley et al 1976;Halperin et al 1993Halperin et al , 2004Ralston et al1982;Babbs 1993;, as well as adjunct devices to be applied during CPR to enhance its positive effects Cohen et al 1992;Mauer et al 1999;Lurie et al 1990Lurie et al , 2001Lurie et al , 2002Tang et al 1997). To evaluate and compare the effectiveness of the various types of CPR compressions and devices, a metric must be chosen that will describe how well each method maintains coronary and systemic blood flow during cardiac arrest and CPR.…”

Section: Introductionmentioning

confidence: 99%

Methods for Calculating Coronary Perfusion Pressure During CPR

et al. 2009

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Coronary perfusion pressure (CPP) is a major indicator of the effectiveness of cardiopulmonary resuscitation in human and animal research studies; however methods for calculating CPP differ among research groups. Here we compare the 6 published methods for calculating CPP using the same data set of aortic (Ao) and right atrial (RA) blood pressures. CPP was computed using each of the 6 calculation methods in an anesthetized pig model, instrumented with catheters with Cobe pressure transducers. Aortic and right atrial pressures were recorded continuously during electrically induced ventricular fibrillation and standard CPR. CPP calculated from the same raw data set by the 6 calculation methods ranged from -1 (signifying retrograde blood flow) to 26 mmHg (mean ± SD of 15 ± 11 mmHg). The CPP achieved by standard closed chest CPR is typically reported as 10-20 mmHg. Within a single study the CPP values may be comparable; however, the CPP values for different studies may not be reliable indicators of the relative efficacies of different CPR methods. Electronically derived, true mean coronary perfusion pressure is arguably the gold standard metric for representing coronary perfusion pressure.

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A Preliminary Study of Cardiopulmonary Resuscitation by Circumferential Compression of the Chest with Use of a Pneumatic Vest

Cited by 191 publications

References 24 publications

Chest Compression Rates During Cardiopulmonary Resuscitation Are Suboptimal

Chest Compression Rates During Cardiopulmonary Resuscitation Are Suboptimal

The mechanism of blood flow during chest compressions for cardiac arrest is probably influenced by the patient's chest configuration

Methods for Calculating Coronary Perfusion Pressure During CPR

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