End-tidal CO 2 -guided automated robot CPR system in the pig. Preliminary communication

Suh, Gil Joon; Park, Jaeheung; Lee, Jung Chan; Na, Sang Hoon; Kwon, Woon Yong; Kim, Kyung Soo; Kim, Taegyun; Jung, Young-Seok; Ko, Jung In; Shin, So Mi; You, Kyoung Min

doi:10.1016/j.resuscitation.2018.04.011

Cited by 13 publications

(18 citation statements)

References 19 publications

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“…We also tried to maintain consistency in chest compression by tying up the pigs on the experimental table with the ropes and holding the pigs during chest compression. In a previous swine CPR experimental study, the robot manipulator showed stable and effective chest compression even with the alteration in the compression points [17].…”

Section: Discussionmentioning

confidence: 83%

“…CPR was started after 3 min of no-flow time. Chest compression was provided using a robot manipulator (VM-6083G model, Denso Co., Ltd., Japan) [16,17] with a constant rate of 100/min and a constant depth of 5 cm, but with different duty cycles according to the assigned group (phase I). Mechanical ventilation was delivered with a rate of 10/min and a tidal volume of 10 mL/kg during CPR.…”

Section: Experimental Protocol (Fig 1)mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 83%

Section: Experimental Protocol (Fig 1)mentioning

confidence: 99%

Duty cycle of 33% increases cardiac output during cardiopulmonary resuscitation

Kim

Suh

et al. 2020

PLoS ONE

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“…It has been suggested that to overcome the venous pooling during heads‐up CPR; a tourniquet‐assisted device may be implemented to overcome the pooling. 25 To improve the hemodynamics of patients in cardiac arrest, the performance of passive leg raising was shown to be unfavorable. 25 , 26 …”

Section: Discussionmentioning

confidence: 99%

Efficacy of heads‐up CPR compared to supine CPR positions: Systematic review and meta‐analysis

Varney

Motawea

Mostafa

et al. 2022

Health Science Reports

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Background and Aim: Cardiopulmonary resuscitation (CPR) in full-coded patients requires effective chest compressions with minimal interruptions to maintain adequate perfusion to the brain and other vital organs. Many novel approaches have been proposed to attain better organ perfusion compared to traditional CPR techniques. The purpose of this review is to investigate the safety and efficacy of heads-up CPR versus supine CPR.Methods: We searched PubMed Central, SCOPUS, Web of Science, and Cochrane databases from 1990 to February 2021. After the full-text screening of 40 eligible studies, only seven studies were eligible for our meta-analysis. We used the RevMan software (5.4) to perform the meta-analysis.Results: In survival outcome, the pooled analysis between heads-up and supine CPR was (risk ratio = 0.98, 95% confidence interval [CI] = 0.17-5.68, p = 0.98). The pooled analyses between heads-up CPR and supine CPR in cerebral flow, cerebral perfusion pressure and coronary perfusion pressure outcomes, were (mean difference [MD] = 0.10, 95% CI = 0.03-0.17, p = 0.003), (MD = 12.28, 95% CI = 5.92-18.64], p = 0.0002), and (MD = 8.43, 95% CI = 2.71-14.14, p = 0.004), respectively. After doing a subgroup analysis, cerebral perfusion was found to increase during heads-up CPR compared with supine CPR at 6 min CPR duration and 18 to 20 min CPR duration as well. Conclusion:Our study suggests that heads-up CPR is associated with better cerebral and coronary perfusion compared to the conventional supine technique in pigs' models. However, more research is warranted to investigate the safety and efficacy of the heads-up technique on human beings and to determine the best angle for optimization of the technique results.

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“…This is because the anatomical position, sternum or chest dimensions, and etiology of cardiac arrest differ among patients. In a study involving a swine model, an end-tidal CO 2 -guided (ET-CO 2 ) automated robot CPR system was developed and verified as effective 19 . An algorithm was able to find the optimal compression position through real-time ET-CO 2 feedback; thus, this robot CPR system may be a promising alternative to M-CPR.…”

Section: Discussionmentioning

confidence: 99%

A novel mechanical chest compressor with rapid deployment in all population cardiopulmonary resuscitation

Sung

Wang

Shieh

et al. 2020

Sci Rep

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Cardiopulmonary resuscitation (CPR) resuscitates patients suffering from cardiac arrest. Mechanical chest compression CPR highlights the need for high CPR quality to facilitate survival and neurological recovery. However, current CPR devices cannot be used on pregnant women or infants. These devices' long re-setup times interrupt CPR and can cause cerebral ischemia. This study designed a novel device with a crank-sliding mechanism. The polar coordinate system (r, θ, z) shortened the setup time and enabled adjustment without moving the patient. We compared our device with commercial products (e.g., LUCAS-2) by quantifying the compression pressure. Control groups for manual CPR of trained physicians and untrained citizens were recruited. We used Resusci Anne products as models. Our results indicated that our design exhibited performance similar to that of LUCAS-2 in adults (557.8 vs. 623.6 mmHg, p = 0.217) and met the current CPR standard guidelines. Notably, our device is applicable to pregnant women [565 vs. 564.5 (adults) mmHg, p = 0.987] and infants [570.8 vs. 564.5 (adults) mmHg, p = 0.801] without lowering the compression quality. The overall compression quality and stability of mechanical chest compression CPR were favorable to those of manual CPR. Our device provides an innovative prototype for the next generation of CPR facilities.Out-of-hospital cardiac arrest is a global public health concern, with 420,000 cases in the United States, 275,000 cases in Europe, and 220,000 cases in Asia documented annually 1-3 . Rates of survival to hospital discharge range between 5% and 20% 2 . Survivors may experience severe neurological sequela even following receipt of sustained return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR), and this increases medical costs and decreases patients' quality of life after hospital discharge. The quality of CPR is key to resuscitation success and long-term prognosis. High-quality CPR, as defined by the American Heart Association and European Resuscitation Council, involves four aspects: a high compression rate (100 to 120 per minute), sufficient compression depth (5 cm in adults and teenagers; 4 cm in infants), full chest recoil, and minimal hands-off time 4,5 . Table 1 lists CPR requirements in multiple populations.To deliver high-quality CPR, manual chest compression CPR (M-CPR) is traditionally the initial tool used for resuscitation. However, various problems with M-CPR can reduce CPR quality, including insufficient compression depth, compression rate variation and consequential low mean arterial pressure, diastolic arterial pressure, and coronary perfusion pressure 6 . Even the highest-quality M-CPR provides only 20%-30% of the usual cardiac output and thus may considerably reduce the ROSC rate or lead to negative neurological outcomes 7 .Recently, the use of mechanical chest compression CPR (Mcc-CPR) has shed light on various aspects related to CPR, including emergency medical services at scenes of accidents, transportation, and resuscitation room...

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End-tidal CO 2 -guided automated robot CPR system in the pig. Preliminary communication

Cited by 13 publications

References 19 publications

Duty cycle of 33% increases cardiac output during cardiopulmonary resuscitation

Duty cycle of 33% increases cardiac output during cardiopulmonary resuscitation

Efficacy of heads‐up CPR compared to supine CPR positions: Systematic review and meta‐analysis

A novel mechanical chest compressor with rapid deployment in all population cardiopulmonary resuscitation

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