Effect of compression waveform and resuscitation duration on blood flow and pressure in swine: One waveform does not optimally serve

Lampe, Joshua W.; Yin, Tai; Bratinov, George; Kaufman, Christopher L.; Berg, Robert A.; Venema, A.; Becker, Lance B.

doi:10.1016/j.resuscitation.2018.08.005

Cited by 9 publications

(11 citation statements)

References 21 publications

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“…Broken ribs change the effect of compressions on inducing forward blood flow, the heart changes from a pump to a reverse pressure-driven system, and redistribution of plasma volume to the interstitium as edema, mesenteric vasculature through pooling, and venule system through loss of arteriole tone. Ultimately, this multi-system redistribution induces a hypotensive state which decreases right atrial filling capacity 26 . Can a single CC waveform maintain the same efficacy through the dynamic changes in CA physiology?…”

Section: Does a Single Ideal Waveform Existmentioning

confidence: 99%

“…Using a swine model to simulate ventricular fibrillation (VF)-induced CA, Lampe et al . used a programmable mechanical CC device to assess the impact of cycling a variety of 2-minute CPR waveforms over the course of 50 compression minutes 26 . Physiologic monitors alongside flow probes at arterial (common carotid, aorta, and abdominal aorta) as well as venous (external jugular, right atrial, and inferior vena cava) sites were used to assess how physiologic parameters change through CA resuscitation as well as the efficacy of difference waveforms in optimizing blood flow over time.…”

Section: Does a Single Ideal Waveform Existmentioning

confidence: 99%

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Recent advances in personalizing cardiac arrest resuscitation

Kuschner

Becker

2019

F1000Res

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Cardiac arrest remains a significant cause of death and disability throughout the world. However, as our understanding of cardiac arrest and resuscitation physiology has developed, new technologies are fundamentally altering our potential to improve survival and neurologic sequela. Some advances are relatively simple, requiring only alterations in current basic life support measures or integration with pre-hospital organization, whereas others, such as extra-corporeal membrane oxygenation, require significant time and resource investments. When combined with consistent rescuer and patient-physiologic monitoring, these innovations allow an unprecedented capacity to personalize cardiac arrest resuscitation to patient-specific pathophysiology. However, as more extensive options are established, it can be difficult for providers to incorporate novel resuscitation techniques into a cardiac arrest protocol which can fit a wide variety of cases with varying complexity. This article will explore recent advances in our understanding of cardiac arrest physiology and resuscitation sciences, with particular focus on the metabolic phase after significant ischemia has been induced. To this end, we establish a practical consideration for providers seeking to integrate novel advances in cardiac arrest resuscitation into daily practice.

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Section: Does a Single Ideal Waveform Existmentioning

confidence: 99%

Section: Does a Single Ideal Waveform Existmentioning

confidence: 99%

Recent advances in personalizing cardiac arrest resuscitation

Kuschner

Becker

2019

F1000Res

Self Cite

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“…On the contrary, another animal experiment showed no association between reduced duty cycle and coronary perfusion pressure [21], with the limitations that the compression rate was 80/min and decompression depth was 2 cm using an active compression-decompression-CPR device, which might have attenuated the effects of shorter duty cycle during relaxation. Lampe et al [22] recently reported on the changes in haemodynamic parameters including aortic blood flow, aortic pressure and CPP during CPR according to compression waveforms with different compression rate and different duty cycle, but they have not concluded which waveform is optimal. The compression rate in the study ranged from 50/min to 150/min, and these values are beyond the recommendation from the guidelines [3,4].…”

Section: Discussionmentioning

confidence: 99%

Duty cycle of 33% increases cardiac output during cardiopulmonary resuscitation

Kim

Suh

et al. 2020

PLoS ONE

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Background The aim of this study was to investigate whether 33% duty cycle increases end-tidal carbon dioxide (ETCO 2) level, a surrogate measurement for cardiac output during cardiopulmonary resuscitation (CPR), compared with 50% duty cycle. Methods Six pigs were randomly assigned to the DC33 or DC50 group. After 3 min of induced ventricular fibrillation (VF), CPR was performed for 5 min with 33% duty cycle (DC33 group) or with 50% duty cycle (DC50 group) (phase I). Defibrillation was delivered until return of spontaneous circulation (ROSC) thereafter. After 30 min of stabilization, the animals were reassigned to the opposite groups. VF was induced again, and CPR was performed (phase II). The primary outcome was ETCO 2 during CPR, and the secondary outcomes were coronary perfusion pressure (CPP), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and right atrial pressure (RAP). Results Mean ETCO 2 was higher in the DC33 group compared with the DC50 group (22.5 mmHg vs 21.5 mmHg, P = 0.018). In a linear mixed model, 33% duty cycle increased ETCO 2 by 1.0 mmHg compared with 50% duty cycle (P < 0.001). ETCO 2 increased over time in the DC33 group [0.6 mmHg/min] while ETCO 2 decreased in the DC50 group [-0.6 mmHg/min] (P < 0.001). Duty cycle of 33% increased SAP (6.0 mmHg, P < 0.001), DAP (8.9 mmHg, P < 0.001) RAP (2.6 mmHg, P < 0.001) and CPP (4.7 mmHg, P < 0.001) compared with the duty cycle of 50%.

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“…The transition in CPR efficacy at 20-23 minutes of asphyxial arrest may not be limited to asphyxia or infant piglets. In models of ventricular fibrillation in infant piglets (39) and 30kg pigs (40), blood flow deteriorates beyond 20 minutes of arrest, even when CPR starts immediately after arrest and chest deformation is limited by the use of a thoracic vest (41). However, species differences can exist because the deterioration of cerebral and myocardial blood flow can be avoided after fibrillatory arrest in adult dogs with different modalities of CPR and epinephrine administration for 60-90 minutes (42,43).…”

Section: Discussionmentioning

confidence: 99%