Left ventricle chest compression improves ETCO2, blood pressure, and cerebral blood velocity in a swine model of cardiac arrest and cardiopulmonary resuscitation

Marshall, Rory A.; Morton, Jude S.; Luchkanych, Adam M.S.; Karsh, Yehia El; Karsh, Zeyad El; Morse, Cameron; Tomczak, Corey R.; Grunau, Brian; Olver, T. Dylan

doi:10.1016/j.resplu.2022.100326

Cited by 8 publications

(4 citation statements)

References 45 publications

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“…Animal studies have shown that by shifting the compression site to the left, a more direct compression of the left ventricle was achieved, thus increasing aortic pressure, CPP, EtCO 2, and rates of ROSC in swine. 33 , 34 Also, in a recent porcine CA model, cerebral blood velocity measurements were significantly greater when the left ventricle was directly compressed during CPR by checking the left ventricle’s position by ultrasound rather than compression in the standard position. 33 Therefore, left-sided rib fractures observed in our experiment may account for a more direct compression of the left ventricle, and thus elevated perfusion pressures.…”

Section: Discussionmentioning

confidence: 99%

Left rib fractures during cardiopulmonary resuscitation are associated with hemodynamic variations in a pig model of cardiac arrest

et al. 2023

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Section: Discussionmentioning

confidence: 99%

Left rib fractures during cardiopulmonary resuscitation are associated with hemodynamic variations in a pig model of cardiac arrest

et al. 2023

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“…Our primary concern is ensuring that the level of LV max targets a volume of cardiac output maximization while avoiding compression of outflow vessels 7 . Prior studies have shown that chest compressions focused on the left ventricle improve hemodynamics and has a greater likelihood of achieving return of spontaneous circulation (ROSC) 11 . Our results suggested that the optimal hand position, i.e., the adjusted height of LV max for a Thai individual with expiration and arm down position (EAD) in this study group was at 89.7 mm above the tip of the xiphoid process which is approximately just below the midpoint of the sternum.…”

Section: Discussionmentioning

confidence: 99%

Optimal chest compression position for cardiopulmonary resuscitation determined by computed tomography image: retrospective cross-sectional analysis

Saksobhavivat,

Phattharapornjaroen,

Suksukon

et al. 2023

Sci Rep

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The objective of this study was to determine the height of optimal hand position for chest compression during adult cardiopulmonary resuscitation (CPR) from the tip of the sternal xiphoid process (TOX) along with the relative heights of the left ventricular outflow tract (LVOT) and abdominal organs among the Thai population. The retrospective cross-sectional study was conducted through a review of medical records and contrast-enhanced chest computed tomography. The total of 204 Thai patients without obvious chest deformity at Ramathibodi Hospital from January to June 2018 was included as part of a multi-regional study. The heights of the level of maximal LV width (LVmax), LOVT, top of liver and stomach with respect to TOX were measured on midline sagittal image. Mean age and body mass index (BMI) were 59.5 years and 23.9 kg/m2, respectively. One hundred and one subjects (49.5%) had pulmonary diseases. Mean height of the LVmax from TOX was 37.7 mm, corresponding to 20% of the sternal length (SL) in the inspiration arm raised position (IAR). The adjusted height of LVmax from TOX in the expiration arm-down position (EAD) was 89.7 mm (48% of SL). The inter-nipple line was at 84.5 mm (45.1% of SL) from TOX on IAR. Among 178 and 109 subjects whose uppermost part of the liver and stomach were above TOX, 80.4% and 94.5% were located within the lower half of the sternum, respectively. The adjusted optimal hand position for chest compression during CPR was at approximately 89.7 mm from TOX in EAD (48% of SL). The hand position at the upper part of the lower half of the sternum is closest to the adjusted LVmax and has a better chance to avoid compression of intraabdominal organs.Trial registration This trial was retrospectively registered on 2 February 2023 in the Thai Clinical Trial Registry, identification number TCTR 20230202006.

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“…The latter group achieved significantly greater ETCO 2 , mean arterial blood pressure, and cerebral blood velocity. While not statistically significant, 17% of pigs achieved ROSC in the LV chest compression group as compared to 0% in the standard chest compression cohort [ 88 ]. In a single swine model utilizing real-time TEE to direct the location of chest compressions, Teran et al demonstrated that when compressions were directed over the LV (as opposed to the LVOT), aortic pressures and ETCO 2 were higher [ 89 ].…”

Section: Monitoring Perfusion During Cardiopulmonary Resuscitation—no...mentioning

confidence: 99%

Physiology-Guided Resuscitation: Monitoring and Augmenting Perfusion during Cardiopulmonary Arrest

Bernard,

Pashun,

Varma

et al. 2024

JCM

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Given the high morbidity and mortality associated with cardiopulmonary arrest, there have been multiple trials aimed at better monitoring and augmenting coronary, cerebral, and systemic perfusion. This article aims to elucidate these interventions, first by detailing the physiology of cardiopulmonary resuscitation and the available tools for managing cardiopulmonary arrest, followed by an in-depth examination of the newest advances in the monitoring and delivery of advanced cardiac life support.

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Left ventricle chest compression improves ETCO2, blood pressure, and cerebral blood velocity in a swine model of cardiac arrest and cardiopulmonary resuscitation

Cited by 8 publications

References 45 publications

Left rib fractures during cardiopulmonary resuscitation are associated with hemodynamic variations in a pig model of cardiac arrest

Left rib fractures during cardiopulmonary resuscitation are associated with hemodynamic variations in a pig model of cardiac arrest

Optimal chest compression position for cardiopulmonary resuscitation determined by computed tomography image: retrospective cross-sectional analysis

Physiology-Guided Resuscitation: Monitoring and Augmenting Perfusion during Cardiopulmonary Arrest

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