Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: a non-randomized interventional cross-over study

Abstract

BackgroundThe objective of this investigation was to evaluate changes in intrathoracic pressure (Ppl), airway pressure (Paw) and vital organ perfusion pressures during standard and intrathoracic pressure regulation (IPR)-assisted cardiopulmonary resuscitation (CPR).MethodsMultiple CPR interventions were assessed, including newer ones based upon IPR, a therapy that enhances negative intrathoracic pressure after each positive pressure breath. Eight anesthetized pigs underwent 4 min of untreated ventricular fibrillation followed by 2 min each of sequential interventions: (1) conventional standard CPR (STD), (2) automated active compression decompression (ACD) CPR, (3) ACD+ an impedance threshold device (ITD) CPR or (4) ACD+ an intrathoracic pressure regulator (ITPR) CPR, the latter two representing IPR-based CPR therapies. Intrapleural (Ppl), airway (Paw), right atrial, intracranial, and aortic pressures, along with carotid blood flow and end tidal CO2, were measured and compared during each CPR intervention.ResultsThe lowest mean and decompression phase Ppl were observed with IPR-based therapies [Ppl mean (mean ± SE): STD (0.8 ± 1.1 mmHg); ACD (−1.6 ± 1.6); ACD-ITD (−3.7 ± 1.5, p < 0.05 vs. both STD and ACD); ACD-ITPR (−7.0 ± 1.9, p < 0.05 vs. both STD and ACD)] [Ppl decompression (mean ± SE): STD (−6.3 ± 2.2); ACD (−13.0 ± 3.8); ACD-ITD −16.9 ± 3.6, p < 0.05 vs. both STD and ACD); ACD-ITPR −18.7 ± 3.5, p < 0.05 vs. both STD and ACD)]. Interventions with the lower mean or decompression phase Ppl also demonstrated lower Paw and were associated with higher vital organ perfusion pressures.ConclusionsIPR-based CPR methods, specifically ACD-ITPR, yielded the most pronounced reduction in both Ppl and Paw and resulted in the most favorable augmentation of hemodynamics during CPR.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0164-5) contains supplementary material, which is available to authorized users.

Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest

“…Temperature was monitored with an esophageal probe, and maintained between 36.5 and 38.5°C Proximal airway pressure, a surrogate for intrathoracic pressure, was measured with a differential pressure transducer (TSD160C, BioPac Systems, Inc., Goleta, CA). 8 Central aortic blood pressures were measured with a micromanometer-tipped catheter (Mikro-Tip Transducer, Millar Instruments, Houston, TX) placed through the right femoral artery into the descending thoracic aorta to the level of the diaphragm. A similar Millar catheter was placed in the right femoral vein and advanced to the right atrium (RA) to measure right atrial pressure.…”

Understanding the Adverse Hemodynamic Effects of Serious Thoracic Injuries During Cardiopulmonary Resuscitation: A Review and Approach Based on the Campbell Diagram

“…Due to the difficulty of measuring pleural pressure and volumes of the chest wall and the lungs separately, in clinical practice, the pressure-volume curve of the respiratory system, which includes the lungs and chest wall, is used to estimate compliance (Figure 1B). The airway pressure (represented by the x-axis) has a good correlation with pleural pressure and right atrial pressure during CPR when airflow is zero (Kwon et al, 2015).…”

Sleep Apnea and Heart

“…Repetitive forceful inspiration against a closed airway generates intrathoracic pressure swings, which in turn can increase left ventricular transmural pressure ( Fig. 1) [2,3]. The resulting surges in sympathetic tone increases arterial stiffness and blood pressure (BP) (Fig.…”

“…Younghoon Kwon, MD 1 , Jeongok Logan, PhD, RN 2 , Snigdha Pusalavidyasagar, MD 3 , Takatoshi Kasai, MD, PhD 4 , Crystal SJ Cheong, MBBS 5 , Chi-Hang Lee, MD 6 plaining many cardiovascular and metabolic consequences of OSA [5]. Moreover, the obstructive events frequently culminate in arousals, thereby disrupting sleep continuity and contributes to some of the symptoms of OSA such as non-restorative sleep and daytime sleepiness.…”