Interposed abdominal compression-CPR: A case study in cardiac arrest research

Abstract

When the abdomen is compressed manually in counterpoint to the rhythm of chest compression, in the performance of interposed abdominal compression-CPR, artificial circulation is approximately doubled in animal experiments and in electronic models of the circulatory system. These studies suggest that external manual compression of the abdominal aorta acts like an intraaortic balloon pump to increase aortic pressure, whereas external manual compression of the abdominal veins acts to prime the right heart and pulmonary vessels before the next chest compression. As a result, perfusion pressures and flows are increased. Several clinical studies of this technique have shown promising results, including improved hemodynamics, resuscitation success, and survival. The history of interposed abdominal compression-CPR research suggests a number of principles that may be useful in the development of other new methods for the management of cardiac arrest, including the virtues of vigorously pursuing a new idea suggested by serendipitous observations, developing and refining a working hypothesis as to pathophysiologic mechanisms, working in interdisciplinary groups, refining a novel technique in stages as experience is gained, and recognizing the need for staged phase 1, 2, and 3 clinical trials in the context of the approximately ten-year gestation period from laboratory inspiration to clinical practice.

Web-based general public opinion study of automated versus manual external chest compression

“…Both techniques can be automated. However, our results apply only to the Autopulse device shown in the video and cannot be generalised to other devices (eg, Lucas or Auto-CPR) without further study 16 17…”

Circulatory adjuncts: Newer methods of cardiopulmonary resuscitation

“…Active compression-decompression CPR 37,38 aims to improve filling of the either the cardiac pump or the thoracic pump by creating negative pressure in the thorax between chest compressions. Interposed abdominal compression (IAC)-CPR [39][40][41][42][43] aims to invoke the abdominal pump together with either chest pump. Both IAC-CPR and its derivative, Lifestick CPR 44 , aim to combine thoracic and abdominal pumps alternately, in such a way that the thoracic pump primes the abdominal pump during one half of the cycle and the abdominal pump primes the thoracic pump during the other half of the cycle.…”

Methods for Calculating Coronary Perfusion Pressure During CPR

“…Investigators have tested various compression forces, rates, and duty cycles, investigated interposed chest and abdominal compressions, and proposed rhythmic abdominal compressions only (Maier et al 1984;Criley et al 1976;Halperin et al 1993Halperin et al , 2004Ralston et al1982;Babbs 1993;, as well as adjunct devices to be applied during CPR to enhance its positive effects Cohen et al 1992;Mauer et al 1999;Lurie et al 1990Lurie et al , 2001Lurie et al , 2002Tang et al 1997). To evaluate and compare the effectiveness of the various types of CPR compressions and devices, a metric must be chosen that will describe how well each method maintains coronary and systemic blood flow during cardiac arrest and CPR.…”