Cardiac Arrest

Jude, James R.

doi:10.1001/jama.1961.03040500005002

Cited by 266 publications

(18 citation statements)

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“…Furthermore, in-hospital CPR has become standardized, following specific guidelines established by the Subcommittee on Emergency Cardiac Care of the American Heart Association. 4 One continuing problem with external cardiac massage is the relatively low cardiac output and coronary blood flow generated by current methods of compression. Absolute values of cardiac output observed in the dog vary considerably, and it is not known whether this variability is caused by differences in methodology or in compression techniques.…”

Section: Discussionmentioning

confidence: 99%

The physiology of external cardiac massage: high-impulse cardiopulmonary resuscitation.

Maier¹,

Tyson²,

Olsen³

et al. 1984

Circulation

266

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In intact chronically instrumented dogs, left ventricular dynamics were studied during cardiopulmonary resuscitation (CPR). Electromagnetic flow probes measured cardiac output and coronary blood flow, ultrasonic transducers measured cardiac dimensions, and micromanometers measured left ventricular, right ventricular, aortic, and intrathoracic pressures. The dogs were anesthetized with morphine, intubated, and fibrillated by rapid ventricular pacing. Data were obtained during manual external massage with dogs in the lateral and supine positions. Force of compression was varied from a peak intrathoracic pressure of 10 to 30 mm Hg, and compression rate was varied from 60 to 150/ min. Increasing force of compression increased stroke volume up to a peak intrathoracic pressure of approximately 20 mm Hg, beyond which stroke volume remained constant or declined. Stroke volume appeared to result primarily from direct transmission of manual compression force to the heart rather than from positive intrathoracic pressure because peak cardiac or vascular pressures or the change in these pressures were consistently two to four times greater than the corresponding intrathoracic pressures during manual compression. With increasing compression rate, stroke volume remained relatively constant, and total cardiac output increased significantly: 425 + 92 ml/min at 60/min, 643 130 ml/min at 100/min, and 975 ± 219 ml/min at 150/min (p < .05). Left ventricular dimensions decreased minimally at higher manual compression rates. In four patients undergoing CPR, systolic and diastolic arterial blood pressure increased with faster compression rates, correlating well with data obtained in the dog. Dynamic coronary blood flow in canine experiments decreased to zero or negative values during compression. Antegrade coronary flow occurred primarily during noncompression periods and seemed to be related to diastolic aortic perfusion pressure; coronary flow at a compression rate of 150/min averaged 75% of control. Therefore stroke volume and coronary blood flow in this canine preparation were maximized with manual chest compression performed with moderate force and brief duration. Increasing rate of compression increased total cardiac output while coronary blood flow was well maintained. Direct cardiac compression appeared to be the major determinant of stroke volume during manual external cardiac massage.

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Section: Discussionmentioning

confidence: 99%

The physiology of external cardiac massage: high-impulse cardiopulmonary resuscitation.

Maier¹,

Tyson²,

Olsen³

et al. 1984

Circulation

266

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“…With relaxation following each external compression, the sternum recoils outward increasing intrathoracic negative pressure and thereby aiding in the venous filling phase of the heart. This point is considered to be of great importance in providing a good cardiac output in the arrested heart.” 5 …”

Section: Introductionmentioning

confidence: 99%

Prevalence and hemodynamic effects of leaning during CPR

et al. 2011

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Background Cardiopulmonary resuscitation (CPR) guidelines recommend complete release between chest compressions (CC). Objective Evaluate the hemodynamic effects of leaning (incomplete chest wall release) during CPR and the prevalence of leaning during CPR. Results In piglet ventricular fibrillation cardiac arrests, 10% and 20% (1.8 kg and 3.6 kg, respectively), leaning during CPR increased right atrial pressures, decreased coronary perfusion pressures, and decreased cardiac index and left ventricular myocardial blood flow by nearly 50%. In contrast, residual leaning of a 260 g accelerometer/ force feedback device did not adversely affect cardiac index or myocardial blood flow. Among 108 adult in-hospital CPR events, leaning ≥2.5 kg was demonstrable in 91% of the events and 12% of the evaluated CC. For 12 children with in-hospital CPR, 28% of CC had residual leaning ≥2.5 kg and 89% had residual leaning ≥0.5 kg. Conclusions Leaning during CPR increases intrathoracic pressure, decreases coronary perfusion pressure, and decreases cardiac output and myocardial blood flow. Leaning is common during CPR.

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“…Complications, in the form of rib damage, have been reported (1,19). However, Jude et al (13) state that it is usually possible to avoid complications by applying the pressure correctly to the lower part of the sternum only. They also state that the method, if properly applied, is harmless to a normally acting heart.…”

Section: Discussionmentioning

confidence: 99%