The Evolution of Abdominal Compression in Cardiopulmonary Resuscitation

Abstract

Objective: To review the history of external abdominal compression as an adjunct to cardiopulmonary resuscitation (CPR), tracking the development of five major themes over the course of the 20th century: 1) augmentation of peripheral resistance by physical means, 2) risk of hepatic injury with abdominal compression, 3) counterpulsation vs sustained compression, 4) the abdominal pump mechanism, and 5) contact compression techniques. Methods: Literature retrieved from successive MEDLINE English‐language searches was reviewed with a special emphasis on work and concepts highlighted by participants at the First Purdue Conference on Interposed Abdominal Compression‐CPR, September 1992. Results: External abdominal compression of one form or another has been studied as a means of resuscitation by many investigators throughout the 20th century. Experimental and clinical studies have shown generally consistent evidence of hemodynamic augmentation by abdominal compression during various forms of CPR. Recent advances include a modified theoretical understanding of hemodynamic mechanisms and demonstration of clinical potential in humans. Inconsistencies in published results may be due to differences in mechanical techniques of abdominal compression. Based on these studies, a modified manual technique for “contact compression” of the abdominal aorta is recommended. Conclusions: A technique for left‐of‐center, angled compression of the abdominal aorta against the crest of the spine is recommended. Further well‐supervised and controlled clinical trials using this standardized technique are warranted as a prelude to more widespread clinical application of abdominal compression in CPR.

Comparison Between Active Abdominal Compression-Decompression Cardiopulmonary Resuscitation and Standard Cardiopulmonary Resuscitation in Asphyctic Cardiac Arrest Rats With Multiple Rib Fractures

“…AACD-CPR is a new form of CPR that involves both active compression and active decompression of the abdomen based on "abdominal pump" theories (8)(9)(10). It is performed by using a handheld suction device attached to the upper abdomen and by actively pushing and pulling on the device (6).…”

“…AACD-CPR, also known as abdominal lifting and compression CPR, is a novel CPR method based on "abdominal pump" theories (8)(9)(10), in which blood flow during cardiac arrest (CA) is produced by rhythmic compression and active decompression of the abdomen instead of chest, using a handheld suction device attached to the upper abdomen. Previous preliminary investigations (4,7) have reported that AACD-CPR is possible and results in higher return of spontaneous circulation (ROSC) rates in patients who had chest trauma and experienced CA, compared with STD-CPR.…”

Assessing the influence of abdominal compression on time to return of circulation during resuscitation of asphyxiated newborn lambs: a randomised preclinical study

“…Abdominal compression (AC) is one strategy that could be used to increase diastolic pressure. 12 Despite intermittent periods of interest, particularly in the military setting (use of ‘military anti-shock trousers’ for major haemorrhage), 13 this approach is not widely used during resuscitation, in any age group. To our knowledge, AC has not been examined in the newborn period, in preclinical or clinical studies.…”

Sustained manual abdominal compression during cardiopulmonary resuscitation in a pig model: a preliminary investigation

“…Some studies have reported an increased incidence of liver laceration with sustained abdominal compression during CPR,3 6 whereas liver laceration has not been found in other studies 2 7 10. Haemodynamic benefits and the risk of liver trauma may be dependent on abdominal compression technique, and the direct compression of the abdominal aorta, rather than a generalised abdominal compression, might augment perfusion during CPR and minimise the risk of liver injury 11. In the present study, we hypothesised that sustained manual abdominal compression (SMAC) using left paramedian compression (fig 1) can improve CPP during CPR and resuscitation outcomes, such as return of spontaneous circulation (ROSC) and 24-hour survival, without causing liver laceration.…”