Optimal control applied to a thoraco-abdominal CPR model

Abstract

The techniques of optimal control are applied to a validated blood circulation model of cardiopulmonary resuscitation (CPR), consisting of a system of seven difference equations. In this system, the non-homogeneous forcing terms are chest and abdominal pressures acting as the 'controls'. We seek to maximize the blood flow, as measured by the pressure difference between the thoracic aorta and the right atrium. By applying optimal control methods, we characterize the optimal waveforms for external chest and abdominal compression during cardiac arrest and CPR in terms of the solutions of the circulation model and of the corresponding adjoint system. Numerical results are given for various scenarios. The optimal waveforms confirm the previously discovered positive effects of active decompression and interposed abdominal compression. These waveforms can be implemented with manual (Lifestick-like) and mechanical (vest-like) devices to achieve levels of blood flow substantially higher than those provided by standard CPR, a technique which, despite its long history, is far from optimal.

Automatic and manual devices for cardiopulmonary resuscitation: A review

“…The LifeStick acts quite differently from the other devices because it performs an interposed abdominal compression-cardiopulmonary resuscitation (IAC-CPR), that is, abdominal compressions alternated to chest compressions. The cyclic alternation of chest and abdominal compressions doubles the flow, [24][25][26] allowing to decrease the depth of compression, and therefore the danger of ribs and sternum injuries. However, compressions have to be less vigorous to prevent injuries to vital organs because the abdomen is softer than the thorax.…”

A dynamic model for tuberculosis transmission and optimal treatment strategies in South Korea

“…Since the number of incidence after the jump at 2001 yr is not decreasing, we apply OC theory to our model for proposing optimal treatment strategies of TB in South Korea. OC theory has been applied in many areas including economics (Dorfman, 1969;Kamien and Schwartz, 1992;Weber, 2005), engineering , biology (Fister et al, 1998;Joshi, 2003;Jung et al, 2002Jung et al, , 2009Kirschner et al, 1997;Lenhart and Workman, 2007) and medicine (Jung et al, , 2006(Jung et al, , 2008Lenhart et al, 2005). In our work, the control plans are associated with three control mechanisms: distancing, case finding and case holding efforts.…”

Comparison of CPR outcome predictors between rhythmic abdominal compression and continuous chest compression CPR techniques

“…For consistency with previous studies and to approximate bystander CPR application, a duty cycle of 50% was used for both CC-CPR and OAC-CPR, though bystander-based CPR may result in a lower duty cycle 40. While a theoretical model of OAC-CPR suggests that a higher duty cycle may be more optimal,41 a preliminary study observed equivalent CPP in both 50% and 70% duty cycles (unpublished data from four porcine subjects). The predictive outcome metrics used indicate internal conditions difficult to observe, but do not directly indicate survival or neurological outcome.…”