A new physiological model for studying the effect of chest compression and ventilation during cardiopulmonary resuscitation: The Thiel cadaver

Charbonney, Emmanuel; Delisle, Stéphane; Savary, Dominique; Bronchti, Gilles; Rigollot, Marceau; Drouet, Adrien; Badat, Bilal; Ouellet, Paul; Gosselin, Patrice; Mercat, Alain; Brochard, Laurent; Richard, Jean-Christophe M.

doi:10.1016/j.resuscitation.2018.01.012

Cited by 35 publications

(53 citation statements)

References 36 publications

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“…Airway closure with a variable degree of opening pressure has been documented in patients with acute respiratory distress syndrome, in human cadavers, and in cardiac arrest patients undergoing cardiopulmonary resuscitation. 1,4,23,24 Different from what initially suggested during general anesthesia, 6,7 the opening pressure is not an airway pressure threshold to overcome pleural pressure and generate positive transpulmonary pressure. Indeed, this phenomenon has been reported in the excised lung, where transpulmonary pressure is necessarily positive, 25,26 and in our study, airway opening often occurred at a transpulmonary pressure lower Fig.…”

Section: Discussionmentioning

confidence: 84%

Airway Closure during Surgical Pneumoperitoneum in Obese Patients

Grieco¹,

Anzellotti²,

Russo³

et al. 2019

Anesthesiology

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Background: Airway closure causes lack of communication between proximal airways and alveoli, making tidal inflation start only after a critical airway opening pressure is overcome. The authors conducted a matched cohort study to report the existence of this phenomenon among obese patients undergoing general anesthesia.Methods: Within the procedures of a clinical trial during gynecological surgery, obese patients underwent respiratory/lung mechanics and lung volume assessment both before and after pneumoperitoneum, in the supine and Trendelenburg positions, respectively. Among patients included in this study, those exhibiting airway closure were compared to a control group of subjects enrolled in the same trial and matched in 1:1 ratio according to body mass index.results: Eleven of 50 patients (22%) showed airway closure after intubation, with a median (interquartile range) airway opening pressure of 9 cm H 2 O (6 to 12). With pneumoperitoneum, airway opening pressure increased up to 21 cm H 2 O (19 to 28) and end-expiratory lung volume remained unchanged (1,294 ml [1,154 to 1,363] vs. 1,160 ml [1,118 to 1,256], P = 0.155), because end-expiratory alveolar pressure increased consistently with airway opening pressure and counterbalanced pneumoperitoneum-induced increases in end-expiratory esophageal pressure (16 cm H 2 O [15 to 19] vs. 27 cm H 2 O [23 to 30], P = 0.005). Conversely, matched control subjects experienced a statistically significant greater reduction in end-expiratory lung volume due to pneumoperitoneum (1,113 ml [1,040 to 1,577] vs. 1,000 ml [821 to 1,061], P = 0.006). With airway closure, static/dynamic mechanics failed to measure actual lung/respiratory mechanics. When patients with airway closure underwent pressure-controlled ventilation, no tidal volume was inflated until inspiratory pressure overcame airway opening pressure.conclusions: In obese patients, complete airway closure is frequent during anesthesia and is worsened by Trendelenburg pneumoperitoneum, which increases airway opening pressure and alveolar pressure: besides preventing alveolar derecruitment, this yields misinterpretation of respiratory mechanics and generates a pressure threshold to inflate the lung that can reach high values, spreading concerns on the safety of pressure-controlled modes in this setting.

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Section: Discussionmentioning

confidence: 84%

Airway Closure during Surgical Pneumoperitoneum in Obese Patients

Grieco¹,

Anzellotti²,

Russo³

et al. 2019

Anesthesiology

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“…Studies performed by the Cardiac Arrest and Ventilation International Association for Research Group demonstrated that in a cadaver model and a bench model of CPR, as well as in a clinical study analyzing capnograms of intubated patients receiving CPR, intrathoracic airway closure occurs in patients receiving CPR, which can limit ventilation. This airway closure was mitigated by the use of PEEP up to 10 cmH 2 O, which also caused some degree of ventilation to occur with the oscillations of air generated by the change in intrathoracic pressure that occurs during the compression and decompression phase of chest compressions [23,24]. The effect that using no PEEP potentially has on oxygenation and DO 2 to the tissues during CPR is also unknown.…”

Section: Discussionmentioning

confidence: 99%

The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation

Levenbrown

Hossain

Keith

et al. 2020

ICMx

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Background: Positive end-expiratory pressure (PEEP) is used to optimize oxygenation by preventing alveolar collapse. However, PEEP can potentially decrease cardiac output through cardiopulmonary interactions. The effect of PEEP on cardiac output during cardiopulmonary resuscitation (CPR) is not known. Methods: This was a preclinical randomized, controlled, animal study conducted in an animal research facility on 25 Landrace-Yorkshire pigs. After inducing cardiac arrest, CPR was performed with LUCAS 3. During CPR, pigs were ventilated at a PEEP of 0, 5, 10, 15, 20 cmH 2 O (randomly determined via lottery) for 9 min. Cardiac output, obtained via ultrasound dilution, and PaO 2 were measured, and oxygen delivery calculated for each PEEP. Results: A mixed-effects repeated-measures analysis of variance was used to compare the baseline value adjusted mean cardiac output, PaO 2 , and oxygen delivery between PEEP groups. Least significant difference test was used to conduct pairwise comparisons between PEEP groups. To determine optimum PEEP, Gaussian mixture model was applied to the adjusted means of cardiac output and oxygen delivery. Increasing PEEP to 10 and higher resulted in significant declines in cardiac output. A PEEP of 15 and higher resulted in significant declines in oxygen delivery. As PEEP was increased from 0 to 20, PaO 2 increased significantly. Gaussian mixture model identified the 0-5 PEEP group as providing optimal cardiac output and oxygen delivery, with PEEP of 5 providing the highest oxygen delivery. Conclusions: A PEEP of 0-5 resulted in the optimal oxygen delivery and cardiac output during CPR, with PEEP of 5 resulting in higher oxygen delivery, and a slightly lower, statistically insignificant cardiac output than PEEP of 0.

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“…The tissue quality, elasticity and handling of THCs are satisfactory, and they have been previously used for teaching and urological skills training (12). The efficacy and role of training using THCs were also reported in other departments (12)(13)(14)(15)(16)(17). Furthermore, the validity and reliability of THCs have also been reported in transperitoneal laparoscopic nephrectomy training (18), as well as in various advanced laparoscopic training courses for colon, hernia and bariatric surgery (10).…”

Section: Discussionmentioning

confidence: 90%

Assessment of laparoscopic training for gynecological malignancies using Thiel‑embalmed human cadavers

et al. 2018

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The introduction of laparoscopic surgery has also been beneficial for patients with gynecological malignancies. In this respect, surgeons should receive related training in the context of human resource development. Hands-on training was introduced using Thiel-embalmed human cadavers (THCs) in 2014. To determine the usefulness of THCs, they were evaluated in terms of tissue color, consistency and operative tactility, among others, compared with in vivo laparoscopic training for gynecological malignancies. Hands-on training sessions using THCs were held for a total of 11 times at Ehime University Graduate School of Medicine between March 2014 and October 2017. Training on THCs included advanced laparoscopic procedures for radical hysterectomy type III. At the end of each training session, data were collected using a standardized, anonymous questionnaire termed the Likert scale. THCs ensured flexibility and plasticity of tissues and organs; therefore, the working space was similar to that in the living body under pneumoperitoneum. After analyzing the quality and consistency of tissue and organ color compared with in vivo conditions, most of the participants agreed or strongly agreed regarding the uterus, adnexa and ureter, but not regarding the large blood vessels. The highest scores were observed in the authenticity of the anatomical condition of each organ. Most participants strongly agreed that training using THCs would help improve their laparoscopic skills with a high level of satisfaction. Furthermore, most participants reported that they would recommend this training to other obstetrician-gynecologists. Laparoscopic training for gynecological malignancies using THCs was comparable to the in vivo conditions in terms of surgical view and operative tactility. Therefore, THCs may be an excellent training tool for improving laparoscopic surgical skills for gynecological malignancies.

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A new physiological model for studying the effect of chest compression and ventilation during cardiopulmonary resuscitation: The Thiel cadaver

Cited by 35 publications

References 36 publications

Airway Closure during Surgical Pneumoperitoneum in Obese Patients

Airway Closure during Surgical Pneumoperitoneum in Obese Patients

The effect of positive end-expiratory pressure on cardiac output and oxygen delivery during cardiopulmonary resuscitation

Assessment of laparoscopic training for gynecological malignancies using Thiel‑embalmed human cadavers

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