Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest

Robert A. Berg, Arthur B Sanders, Karl B Kern, Ronald W. Hilwig, Joseph W. Heidenreich, Matthew E. Porter, Gordon A. Ewy

Research output: Contribution to journalArticle

516 Citations (Scopus)

Abstract

Background - Despite improving arterial oxygen saturation and pH, bystander cardiopulmonary resuscitation (CPR) with chest compressions plus rescue breathing (CC+RB) has not improved survival from ventricular fibrillation (VF) compared with chest compressions alone (CC) in numerous animal models and 2 clinical investigations. Methods and Results - After 3 minutes of untreated VF, 14 swine (32±1 kg) were randomly assigned to receive CC+RB or CC for 12 minutes, followed by advanced cardiac life support. All 14 animals survived 24 hours, 13 with good neurological outcome. For the CC+RB group, the aortic relaxation pressures routinely decreased during the 2 rescue breaths. Therefore, the mean coronary perfusion pressure of the first 2 compressions in each compression cycle was lower than those of the final 2 compressions (14±1 versus 21±2 mm Hg, P<0.001). During each minute of CPR, the number of chest compressions was also lower in the CC+RB group (62±1 versus 92±1 compressions, P<0.001). Consequently, the integrated coronary perfusion pressure was lower with CC+RB during each minute of CPR (P<0.05 for the first 8 minutes). Moreover, at 2 to 5 minutes of CPR, the median left ventricular blood flow by fluorescent microsphere technique was 60 mL·100 g-1·min-1 with CC+RB versus 96 mL· 100 g-1·min-1 with CC, P<0.05. Because the arterial oxygen saturation was higher with CC+RB, the left ventricular myocardial oxygen delivery did not differ. Conclusions - Interrupting chest compressions for rescue breathing can adversely affect hemodynamics during CPR for VF.

Original languageEnglish (US)
Pages (from-to)2465-2470
Number of pages6
JournalCirculation
Volume104
Issue number20
StatePublished - Nov 13 2001
Externally publishedYes

Fingerprint

Cardiopulmonary Resuscitation
Ventricular Fibrillation
Heart Arrest
Respiration
Thorax
Hemodynamics
Oxygen
Perfusion
Advanced Cardiac Life Support
Pressure
Microspheres
Arterial Pressure
Swine
Animal Models

Keywords

  • Cardiopulmonary resuscitation
  • Fibrillation
  • Heart arrest
  • Hemodynamics
  • Ventilation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. / Berg, Robert A.; Sanders, Arthur B; Kern, Karl B; Hilwig, Ronald W.; Heidenreich, Joseph W.; Porter, Matthew E.; Ewy, Gordon A.

In: Circulation, Vol. 104, No. 20, 13.11.2001, p. 2465-2470.

Research output: Contribution to journalArticle

Berg, Robert A. ; Sanders, Arthur B ; Kern, Karl B ; Hilwig, Ronald W. ; Heidenreich, Joseph W. ; Porter, Matthew E. ; Ewy, Gordon A. / Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. In: Circulation. 2001 ; Vol. 104, No. 20. pp. 2465-2470.
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AU - Sanders, Arthur B

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AU - Heidenreich, Joseph W.

AU - Porter, Matthew E.

AU - Ewy, Gordon A.

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N2 - Background - Despite improving arterial oxygen saturation and pH, bystander cardiopulmonary resuscitation (CPR) with chest compressions plus rescue breathing (CC+RB) has not improved survival from ventricular fibrillation (VF) compared with chest compressions alone (CC) in numerous animal models and 2 clinical investigations. Methods and Results - After 3 minutes of untreated VF, 14 swine (32±1 kg) were randomly assigned to receive CC+RB or CC for 12 minutes, followed by advanced cardiac life support. All 14 animals survived 24 hours, 13 with good neurological outcome. For the CC+RB group, the aortic relaxation pressures routinely decreased during the 2 rescue breaths. Therefore, the mean coronary perfusion pressure of the first 2 compressions in each compression cycle was lower than those of the final 2 compressions (14±1 versus 21±2 mm Hg, P<0.001). During each minute of CPR, the number of chest compressions was also lower in the CC+RB group (62±1 versus 92±1 compressions, P<0.001). Consequently, the integrated coronary perfusion pressure was lower with CC+RB during each minute of CPR (P<0.05 for the first 8 minutes). Moreover, at 2 to 5 minutes of CPR, the median left ventricular blood flow by fluorescent microsphere technique was 60 mL·100 g-1·min-1 with CC+RB versus 96 mL· 100 g-1·min-1 with CC, P<0.05. Because the arterial oxygen saturation was higher with CC+RB, the left ventricular myocardial oxygen delivery did not differ. Conclusions - Interrupting chest compressions for rescue breathing can adversely affect hemodynamics during CPR for VF.

AB - Background - Despite improving arterial oxygen saturation and pH, bystander cardiopulmonary resuscitation (CPR) with chest compressions plus rescue breathing (CC+RB) has not improved survival from ventricular fibrillation (VF) compared with chest compressions alone (CC) in numerous animal models and 2 clinical investigations. Methods and Results - After 3 minutes of untreated VF, 14 swine (32±1 kg) were randomly assigned to receive CC+RB or CC for 12 minutes, followed by advanced cardiac life support. All 14 animals survived 24 hours, 13 with good neurological outcome. For the CC+RB group, the aortic relaxation pressures routinely decreased during the 2 rescue breaths. Therefore, the mean coronary perfusion pressure of the first 2 compressions in each compression cycle was lower than those of the final 2 compressions (14±1 versus 21±2 mm Hg, P<0.001). During each minute of CPR, the number of chest compressions was also lower in the CC+RB group (62±1 versus 92±1 compressions, P<0.001). Consequently, the integrated coronary perfusion pressure was lower with CC+RB during each minute of CPR (P<0.05 for the first 8 minutes). Moreover, at 2 to 5 minutes of CPR, the median left ventricular blood flow by fluorescent microsphere technique was 60 mL·100 g-1·min-1 with CC+RB versus 96 mL· 100 g-1·min-1 with CC, P<0.05. Because the arterial oxygen saturation was higher with CC+RB, the left ventricular myocardial oxygen delivery did not differ. Conclusions - Interrupting chest compressions for rescue breathing can adversely affect hemodynamics during CPR for VF.

KW - Cardiopulmonary resuscitation

KW - Fibrillation

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KW - Hemodynamics

KW - Ventilation

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