Age-related effects of compression rate and duration in cardiopulmonary resuscitation

Dean, Janet; Koehler, Raymond C.; Schleien, Charles L.; Berkowitz, Ivor; Michael, J. R.; Atchison, Deborah J.; Rogers, Mark C.; Traystman, R. J.

doi:10.1152/jappl.1990.68.2.554

Cited by 53 publications

(17 citation statements)

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“…The concept of ACD CPR is further supported by the fact that the juvenile chest wall lacks an intrinsic tendency to rebound when released from compression during CPR. As such, Dean et al (13) demonstrated that inadequate chest recoil, development of static chest deforma- tion, and limitation of pulsatile chest wall movement occurred in 8-wk-old pigs when relaxation time was as short as 250 -300 ms during CPR. Because venous blood return to the chest and diastolic right atrial pressure are highly dependent on the intrathoracic pressure drop during the relaxation phase of CPR, we suggest that ACD ϩ ITV CPR in pediatric patients may even contribute more than in adults to the concept of enhancing the bellowslike action of the chest.…”

Section: Discussionmentioning

confidence: 99%

Effects of Active Compression-Decompression Cardiopulmonary Resuscitation with the Inspiratory Threshold Valve in a Young Porcine Model of Cardiac Arrest

et al. 2002

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Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) with the inspiratory threshold valve (ITV) has been recently recommended by the American Heart Association for treatment of adults in cardiac arrest (class IIb: alternative, useful intervention), but this new technique has never been used in a pediatric population. Thus, this study was designed to evaluate ACD ϩ ITV CPR in a young porcine model of cardiac arrest. After 10 min of ventricular fibrillation, and 8 min of standard CPR, ACD ϩ ITV CPR was performed in seven 4-to 6-wk-old pigs (8 -12 kg); defibrillation was attempted 8 min later. Within 2 min after initiation of ACD ϩ ITV CPR, mean (Ϯ SEM) coronary perfusion pressure increased from 18 Ϯ 2 to 24 Ϯ 3 mm Hg (p ϭ 0.018). During standard versus ACD ϩ ITV CPR, mean left ventricular myocardial and total cerebral blood flow was 59 Ϯ 21 versus 126 Ϯ 32 mL·min Ϫ1 ·100 g Ϫ1 , and 36 Ϯ 7 versus 60 Ϯ 15 mL· min Ϫ1 ·100 g Ϫ1 , respectively (p ϭ 0.028). Six of seven animals were successfully defibrillated, and survived Ͼ15 min. In conclusion, the combination of ACD ϩ ITV CPR significantly increased both coronary perfusion pressure and vital organ blood flow after prolonged standard CPR in this young porcine model of ventricular fibrillation. Pediatric cardiopulmonary arrest has a very poor prognosis, and survival rates range only from 2 to 17% (1, 2). Moreover, survivors often remain neurologically disabled (1). Inasmuch as current basic and ACLS methods often fail to restore cardiac function and preserve brain function, new alternative circulation methods merit evaluation in children. In this regard, the American Heart Association and European Resuscitation Council Guidelines emphasize the need for better data regarding epidemiology and treatment of pediatric cardiopulmonary arrest (3, 4).Intermittent impedance to the inflow of respiratory gases during the decompression phase of CPR has recently been shown to enhance CPR efficacy (5). As such, using an ITV improved coronary perfusion pressure and myocardial blood flow in both standard (6) and ACD CPR in adult animal models (7). Furthermore, coronary perfusion pressure was significantly higher in patients receiving ACD CPR with the ITV when compared with ACD CPR alone (8). However, neither ACD CPR alone nor ACD ϩ ITV CPR has been studied in a pediatric population yet, and a suitable ACD device for infants is not currently available. Moreover, in infants undergoing CPR, acquisition of rapid vascular access is not a simple task, even for an experienced emergency physician, and i.v. administration of vasopressor drugs may therefore be delayed, or even impossible. Whereas standard chest compressions alone are often ineffective to ensure adequate vital organ blood flow, ABSTRACT523

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Section: Discussionmentioning

confidence: 99%

Effects of Active Compression-Decompression Cardiopulmonary Resuscitation with the Inspiratory Threshold Valve in a Young Porcine Model of Cardiac Arrest

et al. 2002

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“…A compression to relaxation ratio with a slightly shorter compression than relaxation phase offers theoretical advantages for blood flow in the very young infant. 64 Keep the thumbs or fingers on the sternum during the relaxation phase.…”

Section: Compression Techniquementioning

confidence: 99%

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

2000

Pediatrics

415

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The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC. As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for: • Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. • Preventing heat loss: Hyperthermia should be avoided. • Oxygenation and ventilation: 100% oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO2 detection can be useful in the secondary confirmation of endotracheal intubation. • Chest compressions: Compressions should be administered if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse. • Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01–0.03 mg/kg (0.1–0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available. • Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.

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“…KPR süresi uzadıkça göğüs kompresyon kalitesi kötüleşir ve buna bağlı komplikasyon olasılığı artar (8,9). Süresi uzayan KPR' ye bağlı intra abdominal komplikasyonlar meydana gelebilir (10).…”

Section: Olgu Sunumuunclassified

A Rare Complication of Cardiopulmonary Resuscitation: Liver Injury

Yilmaz¹,

Özbay²,

Anolay³

et al. 2014

JAEMCR

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Introduction: Cardiopulmonary resuscitation (CPR) is a medical process that could be life-saving, but it may also bring about lots of medical complications with regard to CPR. In this case study, we report a legal case with a ruptured liver found at the autopsy.Case Report: A 37-year-old woman, who had angina on her chest formerly, was taken to the hospital in the emergency medicine room as a death. As soon as she arrived there, CPR was applied. Unfortunately, there was no response. After performing the autopsy of her corpse, sternum bone fracture, excessive accumulation of hemorrhage into the abdomen, and liver rupture were discovered.Conclusion: Inappropriate chest compression may cause liver injury during mechanical CPR processes.

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Age-related effects of compression rate and duration in cardiopulmonary resuscitation

Cited by 53 publications

References 0 publications

Effects of Active Compression-Decompression Cardiopulmonary Resuscitation with the Inspiratory Threshold Valve in a Young Porcine Model of Cardiac Arrest

Effects of Active Compression-Decompression Cardiopulmonary Resuscitation with the Inspiratory Threshold Valve in a Young Porcine Model of Cardiac Arrest

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

A Rare Complication of Cardiopulmonary Resuscitation: Liver Injury

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