Chest compliance is altered by static compression and decompression as revealed by changes in anteroposterior chest height during CPR using the ResQPUMP in a human cadaver model

Segal, Nicolas; Robinson, Aaron E.; Berger, Paul; Lick, Michael; Moore, Johanna C.; Salverda, Bayert; Hinke, Mason B.; Ashton, Andrew; McArthur, Angela; Lurie, Keith G.; Metzger, Anja

doi:10.1016/j.resuscitation.2017.04.032

Cited by 22 publications

(16 citation statements)

References 6 publications

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“…It has been found that the anteroposterior distance covered by the sternum after 5 min of CPR with an active compression and decompression device increases significantly (Segal et al, 2017). This finding has been associated with a decrease in thoracic stiffness produced by rib fractures (Oh, 2017).…”

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

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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.

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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

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“…Functional pathophysiological changes of the chest, the heart and the lungs (e.g. lung compliance, cardiac diastolic dysfunction) can potentially affect the hemodynamic effect of standardized cardiopulmonary resuscitation as well [8].…”

Section: Discussionmentioning

confidence: 99%

Correlation between end-tidal carbon dioxide and the degree of compression of heart cavities measured by transthoracic echocardiography during cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Škulec

Vojtisek²,

Černý

2019

Crit Care

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BackgroundThe concept of personalized cardiopulmonary resuscitation (CPR) requires a parameter that reflects its hemodynamic efficiency. While intra-arrest ultrasound is increasingly implemented into the advanced life support, we realized a pre-hospital clinical study to evaluate whether the degree of compression of the right ventricle (RV) and left ventricle (LV) induced by chest compressions during CPR for out-of-hospital cardiac arrest (OHCA) and measured by transthoracic echocardiography correlates with the levels of end-tidal carbon dioxide (EtCO2) measured at the time of echocardiographic investigation.MethodsThirty consecutive patients resuscitated for OHCA were included in the study. Transthoracic echocardiography was performed from a subcostal view during ongoing chest compressions in all of them. This was repeated three times during CPR in each patient, and EtCO2 levels were registered. From each investigation, a video loop was recorded. Afterwards, maximal and minimal diameters of LV and RV were obtained from the recorded loops and the compression index of LV (LVCI) and RV (RVCI) was calculated as (maximal − minimal/maximal diameter) × 100. Maximal compression index (CImax) defined as the value of LVCI or RVCI, whichever was greater was also assessed. Correlations between EtCO2 and LVCI, RVCI, and CImax were expressed as Spearman’s correlation coefficient (r).ResultsEvaluable echocardiographic records were found in 18 patients, and a total of 52 measurements of all parameters were obtained. Chest compressions induced significant compressions of all observed cardiac cavities (LVCI = 20.6 ± 13.8%, RVCI = 34.5 ± 21.6%, CImax = 37.4 ± 20.2%). We identified positive correlation of EtCO2 with LVCI (r = 0.672, p < 0.001) and RVCI (r = 0.778, p < 0.001). The strongest correlation was between EtCO2 and CImax (r = 0.859, p < 0.001). We identified that a CImax cut-off level of 17.35% predicted to reach an EtCO2 level > 20 mmHg with 100% sensitivity and specificity.ConclusionsEvaluable echocardiographic records were reached in most of the patients. EtCO2 positively correlated with all parameters under consideration, while the strongest correlation was found between CImax and EtCO2. Therefore, CImax is a candidate parameter for the guidance of hemodynamic-directed CPR.Trial registrationClinicalTrial.gov, NCT03852225. Registered 21 February 2019 - Retrospectively registered.

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“…Studies have shown that CPR assist devices, like the ResQPUMP, improved chest compliance which improves end organ blood flow [17][18][19] . One study concluded that chest compliance is increased significantly using the ResQPUMP [20] . To identify potential changes in chest compliance, anterior posterior (AP) chest height measurements were performed on newly deceased (never frozen) human cadavers during CPR.…”

Section: Physiologically Focusedmentioning

confidence: 99%

The ResQCPR System: An Objective and Systematic Review

Goodwin

Zeid

Belok

2021

ijirms

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The resource-limiting environment of the pre-hospital setting necessitates the continuous development of tools and interventions that maximise the capabilities of emergency medical services (EMS) municipalities. One such product developed by Zoll, the ResQCPR system, attempts to enhance the effectiveness of prehospital cardiopulmonary resuscitation (CPR). The ResQCPR system is comprised of the ResQPOD, which is an impedance threshold device (ITD), and the ResQPUMP, which is an assisted compression-decompression (ACD) device. Limited data exists regarding Zoll’s specific apparatuses as well as similar such devices. This systematic analysis comprehensively summarises a number of related studies. Their methods, limitations, results, and other aspects are outlined in the respective sections. Conclusion: This review concludes by determining that the effectiveness of the ResQPUMP, in particular (and ACD devices in general), is promising while the ResQPOD’s is uncertain. Future studies are needed to determine whether the effectiveness of the ResQPUMP markedly diminishes when used independently of the ResQPOD. This is an important feature for fire departments and other EMS municipalities because outfitting all appropriate units with both devices can be quite costly. Further studies are also needed to demonstrate reproducibility in humans (because 2 of the studies used pigs as test subjects) and with a greater amount of test subjects.

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Chest compliance is altered by static compression and decompression as revealed by changes in anteroposterior chest height during CPR using the ResQPUMP in a human cadaver model

Cited by 22 publications

References 6 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

Correlation between end-tidal carbon dioxide and the degree of compression of heart cavities measured by transthoracic echocardiography during cardiopulmonary resuscitation for out-of-hospital cardiac arrest

The ResQCPR System: An Objective and Systematic Review

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