Association between left ventricular outflow tract opening and successful resuscitation after cardiac arrest

Catena, E; Ottolina, Davide; Fossali, Tommaso; Rech, Roberto; Borghi, Beatrice; Perotti, Andrea; Ballone, Elisabetta; Bergomi, Paola; Corona, Alberto; Castelli, Antonio; Colombo, Riccardo

doi:10.1016/j.resuscitation.2019.02.027

Cited by 47 publications

(20 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A study based on consecutive CT scans of 677 patients described that the LVOT was under the lower part of the sternum in 36.64% of the cases (Papadimitriou et al, 2013). In a recent series of patients included in an extracorporeal CPR protocol, more than 50% had a closed LVOT during chest compression, and this was associated with poor clinical outcomes (Catena et al, 2019). The sternum can produce protruding edges, and multiple rib fractures can flatten the anterior thoracic wall, leading to such intrathoracic injuries as cardiac contusions (Ihnát Rudinská et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram

et al. 2019

View full text Add to dashboard Cite

Chest compressions during cardiopulmonary resuscitation (CPR) generate cardiac output during cardiac arrest. Their quality performance is key to achieving the return of spontaneous circulation. Serious thoracic injuries (STIs) are common during CPR, and they can change the shape and mechanics of the thorax. Little is known about their hemodynamic effects, so a review of this emerging concept is necessary. The Campbell diagram (CD) is a theoretical framework that integrates the lung and chest wall pressure-volume curves, allowing us to assess the consequences of STIs on respiratory mechanics and hemodynamics. STIs produce a decrease in the compliance of the chest wall and lung. The representation of STIs on the CD shows a decrease in the intrathoracic negative pressure and a functional residual capacity decrease during the thoracic decompression, leading to a venous return impairment. The thorax with STIs is more vulnerable to the adverse hemodynamic effects of leaning, hyperventilation, and left ventricular outflow tract obstruction during CPR. A better understanding of the effects of STIs during CPR, and the study of avoidable injuries, can help to improve the effectiveness of chest compressions and the survival in cardiac arrest.

show abstract

Section: Introductionmentioning

confidence: 99%

Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In addition to the same diagnostic and prognostic role provided by TTE (e.g., identification of reversible causes such as cardiac tamponade or PE), TEE also provides several unique advantages that should be considered. During resuscitation, TEE has the potential to optimize the quality of chest compressions by identifying compression of the left ventricular outflow tract, 15,27 shorten chest compression interruptions, 28 and guide resuscitative procedures such as extracorporeal membrane oxygenation (ECMO). 29,30 In the case of patients with suspected or confirmed COVID-19, clinicians should carefully consider the potential benefits of this procedure against the risks, specifically to health care providers.…”

Section: Cardiac Arrest and Periarrestmentioning

confidence: 99%

Critical Care Transesophageal Echocardiography in Patients during the COVID-19 Pandemic

Teran

Burns

Narasimhan

et al. 2020

Journal of the American Society of Echocardiography

View full text Add to dashboard Cite

Background: The COVID-19 pandemic has placed an extraordinary strain on healthcare systems across North America. Defining the optimal approach for managing a critically ill COVID-19 patient is rapidly changing. Goaldirected transesophageal echocardiography (TEE) is frequently used by physicians caring for intubated critically ill patients as a reliable imaging modality that is well suited to answer questions at bedside. Methods: A multidisciplinary (intensive care, critical care cardiology, and emergency medicine) group of experts in point-of-care echocardiography and TEE from the United States and Canada convened to review the available evidence, share experiences, and produce a consensus statement aiming to provide clinicians with a framework to maximize the safety of patients and healthcare providers when considering focused point-of-care TEE in critically ill patients during the COVID-19 pandemic. Results: Although transthoracic echocardiography can provide the information needed in most patients, there are specific scenarios in which TEE represents the modality of choice. TEE provides acute care clinicians with a goal-directed framework to guide clinical care and represents an ideal modality to evaluate hemodynamic instability during prone ventilation, perform serial evaluations of the lungs, support cardiac arrest resuscitation, and guide veno-venous ECMO cannulation. To aid other clinicians in performing TEE during the COVID-19 pandemic, we describe a set of principles and practical aspects for performing examinations with a focus on the logistics, personnel, and equipment required before, during, and after an examination. Conclusions: In the right clinical scenario, TEE is a tool that can provide the information needed to deliver the best and safest possible care for the critically ill patients.

show abstract

“…In recent years, use of transesophageal echocardiography (TEE) during human cardiac arrest has emerged as a means of guiding resuscitation and improving chest compressions. CPR quality can be improved by moving the area of compression according to visualized LV changes, including greatest LV compression [12,13], alleviation of outflow obstruction [14], and opening of the mitral valve with ventricular filling [15]. Evidence of increased cross-sectional area of the descending aorta immediately proximal to the point of maximal compression suggests that such compressions may have the added benefit of preferential cerebral blood flow [5].…”

Section: Introductionmentioning

confidence: 99%

A Novel Anatomic Landmark to Target the Left Ventricle During Chest Compressions in Cardiac Arrest

Olszynski

Bryce

Hussain

et al. 2021

Cureus

View full text Add to dashboard Cite

Background Resuscitation guidelines recommend that chest compressions be performed over the lower sternum. Current computed tomography and magnetic resonance imaging studies suggest that the current area of compression does not target the left ventricle (LV). Using transthoracic ultrasound, we sought to identify potential anatomic landmarks that would result in compressions over the LV in the majority of our study participants. Methodology We recruited 64 healthy men and women (over the age of 40) from the Simulated Patient Program at the University of Saskatchewan. Using ultrasound, we identified the LV and the associated surface anatomy in terms of intercostal space (ICS) and parasternal or mid-clavicular lines. We also collected biometric data including body mass index, chest circumference, and the corresponding inter-nipple line ICS. Results The LV was located along the left sternal border in 62 (96.9%) participants. The most frequent LV location was along the left sternal border at the sixth ICS in 26 (40.6%) participants, with 13 (20.3%) at the fifth and 10 (15.6%) participants at the seventh ICS. In two (3.1%) participants, the LV was found along the mid-clavicular zone at the fifth ICS. The area from the fifth to seventh ICS on the left sternal border, typically covered by an adult palm centered at the sixth ICS, overlaid 49 of 64 (76.6%, 95% confidence interval [CI]: 64.3-86.2%) identified LV locations. By comparison, centering the heel of the palm over the inter-nipple line at the left sternal border would cover the LV in 46 (71.9%, 95% CI: 59.2-82.4%) participants. Conclusions A novel area of compression over the left sternal border at the inter-nipple line would result in compressions over the LV in nearly three-quarters of our study participants. Future research should investigate whether this proposed area of compression is applicable to a broader population including those with cardiac and thoracic disease.

show abstract

Association between left ventricular outflow tract opening and successful resuscitation after cardiac arrest

Cited by 47 publications

References 28 publications

Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram

Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram

Critical Care Transesophageal Echocardiography in Patients during the COVID-19 Pandemic

A Novel Anatomic Landmark to Target the Left Ventricle During Chest Compressions in Cardiac Arrest

Contact Info

Product

Resources

About