Prevalence and hemodynamic effects of leaning during CPR

Abstract

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.

Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital

“…46 Although data are sparse regarding outcomes related to leaning, animal studies have shown that leaning increases right atrial pressure and decreases cerebral and coronary perfusion pressure, cardiac index, and left ventricular myocardial flow. [46][47][48] Human studies show that a majority of rescuers often lean during CPR and do not allow the chest to recoil fully. 49,50 Therefore, the expert panel agrees that leaning should be minimized.…”

Effect of Chest Compression Leaning on Accelerometry Waveforms

“…For adult patients, leaning is conventionally defined as > 2.5 kg of residual force [4], but the impact of sternal force on hemodynamics is continuous, no safe limit has been documented, and optimal treatment of intermediate levels of residual force is unclear.…”

“…CPR monitors provide feedback on rate, depth and release force (RF) of chest compressions. Excessive RF ("leaning") is common in practice and impedes chest wall recoil, venous return, and blood flow [4]. Leaning can be reduced with real-time feedback [5,6].…”

Advanced Cardiac Life Support: 2016 Singapore Guidelines

“…'Residual leaning' on the chest after each compression by the rescuer impairs the coronary perfusion pressures and cardiac index, which are crucial for myocardial and systemic perfusion, respectively, (17) during CPR. ACLS crew performing manual CPR must pay special attention to ensure complete chest recoil between compressions.…”