Adverse Hemodynamic Effects of Interrupting Chest Compressions for Rescue Breathing During Cardiopulmonary Resuscitation for Ventricular Fibrillation Cardiac Arrest

Abstract

Background-Despite improving arterial oxygen saturation and pH, bystander cardiopulmonary resuscitation (CPR) with chest compressions plus rescue breathing (CCϩRB) has not improved survival from ventricular fibrillation (VF) compared with chest compressions alone (CC) in numerous animal models and 2 clinical investigations. Methods and Results-After 3 minutes of untreated VF, 14 swine (32Ϯ1 kg) were randomly assigned to receive CCϩRB or CC for 12 minutes, followed by advanced cardiac life support. All 14 animals survived 24 hours, 13 with good neurological outcome. For the CCϩRB group, the aortic relaxation pressures routinely decreased during the 2 rescue breaths. Therefore, the mean coronary perfusion pressure of the first 2 compressions in each compression cycle was lower than those of the final 2 compressions (14Ϯ1 versus 21Ϯ2 mm Hg, PϽ0.001). During each minute of CPR, the number of chest compressions was also lower in the CCϩRB group (62Ϯ1 versus 92Ϯ1 compressions, PϽ0.001). Consequently, the integrated coronary perfusion pressure was lower with CCϩRB during each minute of CPR (PϽ0.05 for the first 8 minutes). Moreover, at 2 to 5 minutes of CPR, the median left ventricular blood flow by fluorescent microsphere technique was 60 mL · 100 g Ϫ1 · min Ϫ1 with CCϩRB versus 96 mL · 100 g Ϫ1 · min Ϫ1 with CC, PϽ0.05. Because the arterial oxygen saturation was higher with CCϩRB, the left ventricular myocardial oxygen delivery did not differ. Conclusions-Interrupting chest compressions for rescue breathing can adversely affect hemodynamics during CPR for

Out‐of‐hospital cardiac arrest: studies on aetiology, treatment and outcome

“…CPR performed with 15 chest compressions (at a rate of 100/min) and 2 rescue breathings compared to continuous chest compressions at the same rate showed a compromised effect on haemodynamics in ventilated swine (Berg et al 2001). Since ventilation has been considered an essential part of CPR, the impact on the survival of the cardiac arrest patient should be positive.…”

“…The need for initial mouth-to-mouth ventilation and subsequent assisted ventilation has been challenged in CPR (Berg et al 1993, Berg et al 2001). CPR performed with 15 chest compressions (at a rate of 100/min) and 2 rescue breathings compared to continuous chest compressions at the same rate showed a compromised effect on haemodynamics in ventilated swine (Berg et al 2001).…”

Cardiocerebral and cardiopulmonary resuscitation – 2017 update

“…In that recorded EMS emergency call it must have taken some time before the paramedics arrived, as the wife eventually asked the phone dispatcher, “Why is it every time I press on his chest he opens his eyes, and every time I stop and breathe for him he goes back to sleep?”33 Obviously blood flow to the arrested individual's brain became inadequate soon after chest compressions were interrupted for MTM ventilations.…”

Hands-on defibrillation and electrocardiogram artefact filtering technology increases chest compression fraction and decreases peri-shock pause duration in a simulation model of cardiac arrest

“…1,2 Guidelines have emphasized minimizing CPR pauses with the intent of maintaining coronary perfusion pressure and increasing the likelihood of return of spontaneous circulation. 3,4 Previous work has demonstrated an association between increased chest compression fraction (CCF: the percentage of time during cardiac arrest that is spent performing chest compressions) and increased likelihood of discharge from the hospital in out-of-hospital cardiac arrest (OHCA).…”