Augmentation of carotid flow during cardiopulmonary resuscitation by ventilation at high airway pressure simultaneous with chest compression

Chandra, Nisha; Weisfeldt, Myron L.; Tsitlik, Joshua E.; Vaghaiwalla, F; Snyder, Louis D.; Hoffecker, Margaret; Rudikoff, Michael T.

doi:10.1016/0002-9149(81)90320-9

Cited by 157 publications

(45 citation statements)

References 14 publications

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“…CRILEY et al [85] reported that consciousness could be maintained by coughing during cardiac arrest, with no chest compression. Cardiopulmonary resuscitation (CPR) pressures and flows are higher when they occur simultaneous with lung inflation, which would tend to prevent direct cardiac compression [87,88]. Effective CPR can be provided by a circumferential inflatable vest, which does not compress the heart [89,90].…”

Section: Steady-state Effects Positive End-expiratory Pressure and Comentioning

confidence: 99%

“…Effective CPR can be provided by a circumferential inflatable vest, which does not compress the heart [89,90]. Several studies have demonstrated equal increases in pleural and all intrathoracic vascular pressures during compression [87,88]. Imaging studies have shown the mitral valve remains open during chest compression, a finding incompatible with the cardiac pump theory [91,92].…”

Section: Steady-state Effects Positive End-expiratory Pressure and Comentioning

confidence: 99%

“…Simultaneous compression and ventilation CPR (SCV-CPR) was studied in large clinical trials because stroke volume was shown to be greater in some animal experiments using this technique [87,98]. However, the outcome in clinical trials was disappointing [99].…”

Section: Steady-state Effects Positive End-expiratory Pressure and Comentioning

confidence: 99%

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Heart-lung interactions: applications in the critically ill

Fessler¹

1997

Eur Respir J

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Since the circulatory and pulmonary systems are both driven by pressure and share space in the thorax, it is inevitable that they interact. These mechanical interactions, whilst relatively few in number, are protean in their manifestations.The circulatory system of the critically ill is often particularly susceptible to interference from respiration. Compensatory reserve is limited, ventilatory effort increased, and many critical care respiratory interventions place strain on the circulation, not seen in health.This review will examine the basic physiological mechanisms through which the pulmonary and circulatory systems interact. These mechanisms will then be applied to a variety of weaning, positive end-expiratory pressure (PEEP), and cardiopulmonary resuscitation techniques. It is hoped that this will provide the tools to understand clinical observations which would otherwise appear inexplicable.

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Section: Steady-state Effects Positive End-expiratory Pressure and Comentioning

confidence: 99%

Section: Steady-state Effects Positive End-expiratory Pressure and Comentioning

confidence: 99%

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Heart-lung interactions: applications in the critically ill

Fessler¹

1997

Eur Respir J

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“…The mechanism believed to generate forward blood flow in most animal models [19] and in most human patients [20,21] is termed the "thoracic pump mechanism." The thoracic pump mechanism of closed chest CPR [8,22,23] involves pressurization of the entire pulmonary vascular bed in such a way as to squeeze blood from the lungs, through the left heart, and into the periphery--even in the absence of direct heart compression.…”

Section: Operation Of the Modelmentioning

confidence: 99%

Theoretical advantages of abdominal counterpulsation in CPR as demonstrated in a simple electrical model of the circulation

Babbs

Ralston

Geddes

1984

Annals of Emergency Medicine

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Animal studies and preliminary clinical observations suggest that the addition of interposed abdominal compressions (IAC) to ventilation and chest compression of standard cardiopulmonary resuscitation (CPR) augments blood flow, blood pressures, and immediate survival. To investigate the physical basis for enhanced circulation during IAC-CPR, we developed an electrical model of the circulation. Heart and blood vessels were modeled as resistive-capacitive networks, pressures as voltages, blood flow as electric current, blood inertia as inductance, and the cardiac and venous valves as diodes. External pressurization of the heart and great vessels, as would occur in CPR, was simulated by application by half-sinusoidal voltage pulses between vascular capacitances and ground. Closed-chest CPR was simulated by pressurization of all intrathoracic capacitances. IAC was simulated by similar pressurization of the inferior vena cava and abdominal aorta, 180 degrees out of phase with chest compression. During simulation of CPR, IAC improved cranial and myocardial perfusion at all levels of chest compression pressure by amounts linearly related to peak abdominal pressure, suggesting that the abdomen can function as a second, independent blood pump during CPR. Brain and heart flow were improved further during simulated vasoconstriction in kidneys, abdominal viscera, and extremities. Based on the fundamental properties of the cardiovascular system represented in the model, abdominal counterpulsation provides a rational basis for flow augmentation during CPR.

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“…The piston system was modified to perform chest compressions simultaneously with high pressure ventilation (60-100 cm H 2 0). (8) This system was named Simultaneous Compression and Ventilation CPR (SCV-CPR). In human studies of SCV-CPR, there was no consistent hemodynamic benefit reported for SCV-CPR .…”

Section: Piston Chest Compressionsmentioning

confidence: 99%

Mechanical CPR devices

2010

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Augmentation of carotid flow during cardiopulmonary resuscitation by ventilation at high airway pressure simultaneous with chest compression

Cited by 157 publications

References 14 publications

Heart-lung interactions: applications in the critically ill

Heart-lung interactions: applications in the critically ill

Theoretical advantages of abdominal counterpulsation in CPR as demonstrated in a simple electrical model of the circulation

Mechanical CPR devices

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