Standard CPR versus interposed abdominal compression CPR in shunted single ventricle patients: comparison using a lumped parameter mathematical model

Abstract

Introduction: Cardiopulmonary resuscitation (CPR) in the shunted single-ventricle population is associated with poor outcomes. Interposed abdominal compression-cardiopulmonary resuscitation, or IAC-CPR, is an adjunct to standard CPR in which pressure is applied to the abdomen during the recoil phase of chest compressions. Methods: A lumped parameter model that represents heart chambers and blood vessels as resistors and capacitors was used to simulate blood flow in both Blalock-Taussig-Thomas and Sano circulations. For standard CPR, a prescribed external pressure waveform was applied to the heart chambers and great vessels to simulate chest compressions. IAC-CPR was modelled by adding phasic compression pressure to the abdominal aorta. Differential equations for the model were solved by a Runge-Kutta method. Results: In the Blalock-Taussig-Thomas model, mean pulmonary blood flow during IAC-CPR was 30% higher than during standard CPR; cardiac output increased 21%, diastolic blood pressure 16%, systolic blood pressure 8%, coronary perfusion pressure 17%, and coronary blood flow 17%. In the Sano model, pulmonary blood flow during IAC-CPR increased 150%, whereas cardiac output was improved by 13%, diastolic blood pressure 18%, systolic blood pressure 8%, coronary perfusion pressure 15%, and coronary blood flow 14%. Conclusions: In this model, IAC-CPR confers significant advantage over standard CPR with respect to pulmonary blood flow, cardiac output, blood pressure, coronary perfusion pressure, and coronary blood flow. These results support the notion that single-ventricle paediatric patients may benefit from adjunctive resuscitation techniques, and underscores the need for an in-vivo trial of IAC-CPR in children.

Trends in In-Hospital Cardiac Arrest and Mortality Among Children With Cardiac Disease in the Intensive Care Unit

“…For example, given that patients with SV have the highest risk of IHCA, researchers are investigating optimal CPR strategies suggesting an optimal chest compression position corresponding to the 25% of the lower sternum, 44 or the use of interposed abdominal compression CPR in patients after the Norwood stage 1 palliation. 45 Specific resuscitation strategies—with respect to chest compressions, ventilation, and pharmacologic approach—should be investigated for children with different physiologies, such as children with parallel vs in-series circulation or in those with passive vs antegrade pulmonary blood flow. Studies are also needed to investigate the role of specific drugs for which the level of evidence is low, such as calcium and bicarbonates.…”

Abdominal compressions during cardiopulmonary resuscitation: a scoping review

“…Similarly, the CTAI technique was compared using a concentrated parameter mathematical model in patients with a single ventricle shunt, which corresponds to a congenital heart disease of unique physiology, in which it is extremely difficult to resuscitate due to severe hypoxemia during CPR. Thus, Stromberg et al (2022) (34) evidenced that the use of this technique contributes to increased pulmonary blood flow, cardiac output, blood pressure, coronary perfusion pressure, and coronary blood flow, compared to standard CPR.…”

iCVS - Inferring Cardio-Vascular hidden States from physiological signals available at the bedside

“…First, as noted above, mechanistic models require estimating multiple hidden physiological parameters and variables: inverse problems are notoriously difficult, and their solutions are often non-unique. To overcome such difficulties, prior works reduced the number of free parameters by assuming constant values for some of the parameters, often taken from the literature to describe a "typical subject" [2], [5], [6], [7], [8]. However, physiological properties can vary considerably between subjects, and attempting to use a "one size fits all" parameter often fails to properly characterize most patients.…”