Comparison of standard CPR versus diffuse and stacked hand position interposed abdominal compression-CPR in a swine model

Lyndon Xavier, Karl B Kern, Robert A. Berg, Ronald W. Hilwig, Gordon A. Ewy

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) is an innovative basic life support technique requiring no mechanical adjuncts. Optimizing its performance remains a challenge. Hand-position technique over the abdomen during interposed abdominal compression (IAC) may be important. The purpose of this study was to determine if there is a difference in efficacy depending on the type of abdominal hand-position used. Two different hand positions were studied: open hands, placed side by side, resulting in diffuse abdominal compression and stacked hands, with one on top of the other, producing a more focal compression of the abdomen. Thirty swine were cannulated with micromanometer-tipped pressure transducers in the ascending aorta (Ao) and right atrium (RA), and Millar Doppler-tipped catheters in the descending aorta and inferior vena cava (IVC) to determine flow patterns during cardiopulmonary resuscitation (CPR), During CPR there were no differences in aortic systolic or right atrial systolic pressures. Both forms of IAC-CPR produced greater aortic diastolic and right atrial diastolic pressures then standard CPR (STD-CPR) (P<0.05). Coronary perfusion pressures (CPP), however, were not different. Blood flow directions and velocity patterns showed that STD-CPR chest compressions produce caudally directed blood flow in both the descending aorta and the IVC, and that such flows reverse (becoming cranially directed) during the relaxation phase of chest compression. IAC-CPR produced similar blood flow patterns in the aorta and IVC, as seen with STD-CPR. There were no differences in blood flow patterns between the different forms of IAC-CPR. No CPR-produced trauma difference was found. Abdominal hand position (diffuse or stacked) did not affect blood flow in either the aorta or IVC or resuscitation success in this experimental model. There was a trend towards better outcomes with stacked hands IAC-CPR with 90 versus 70% survival with STD-CPR.

Original languageEnglish (US)
Pages (from-to)337-344
Number of pages8
JournalResuscitation
Volume59
Issue number3
DOIs
StatePublished - Dec 2003

Fingerprint

Cardiopulmonary Resuscitation
Swine
Hand
Inferior Vena Cava
Aorta
Atrial Pressure
Thoracic Aorta
Abdomen
Thorax
Blood Pressure
Pressure Transducers
Blood Flow Velocity
Heart Atria
Resuscitation
Theoretical Models
Catheters
Perfusion

Keywords

  • Cardiac arrest
  • Interposed abdominal compression CPR
  • Resuscitation
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Comparison of standard CPR versus diffuse and stacked hand position interposed abdominal compression-CPR in a swine model. / Xavier, Lyndon; Kern, Karl B; Berg, Robert A.; Hilwig, Ronald W.; Ewy, Gordon A.

In: Resuscitation, Vol. 59, No. 3, 12.2003, p. 337-344.

Research output: Contribution to journalArticle

Xavier, Lyndon ; Kern, Karl B ; Berg, Robert A. ; Hilwig, Ronald W. ; Ewy, Gordon A. / Comparison of standard CPR versus diffuse and stacked hand position interposed abdominal compression-CPR in a swine model. In: Resuscitation. 2003 ; Vol. 59, No. 3. pp. 337-344.
@article{c10746cbfdf44fd99ff28d0ab1128cec,
title = "Comparison of standard CPR versus diffuse and stacked hand position interposed abdominal compression-CPR in a swine model",
abstract = "Interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) is an innovative basic life support technique requiring no mechanical adjuncts. Optimizing its performance remains a challenge. Hand-position technique over the abdomen during interposed abdominal compression (IAC) may be important. The purpose of this study was to determine if there is a difference in efficacy depending on the type of abdominal hand-position used. Two different hand positions were studied: open hands, placed side by side, resulting in diffuse abdominal compression and stacked hands, with one on top of the other, producing a more focal compression of the abdomen. Thirty swine were cannulated with micromanometer-tipped pressure transducers in the ascending aorta (Ao) and right atrium (RA), and Millar Doppler-tipped catheters in the descending aorta and inferior vena cava (IVC) to determine flow patterns during cardiopulmonary resuscitation (CPR), During CPR there were no differences in aortic systolic or right atrial systolic pressures. Both forms of IAC-CPR produced greater aortic diastolic and right atrial diastolic pressures then standard CPR (STD-CPR) (P<0.05). Coronary perfusion pressures (CPP), however, were not different. Blood flow directions and velocity patterns showed that STD-CPR chest compressions produce caudally directed blood flow in both the descending aorta and the IVC, and that such flows reverse (becoming cranially directed) during the relaxation phase of chest compression. IAC-CPR produced similar blood flow patterns in the aorta and IVC, as seen with STD-CPR. There were no differences in blood flow patterns between the different forms of IAC-CPR. No CPR-produced trauma difference was found. Abdominal hand position (diffuse or stacked) did not affect blood flow in either the aorta or IVC or resuscitation success in this experimental model. There was a trend towards better outcomes with stacked hands IAC-CPR with 90 versus 70{\%} survival with STD-CPR.",
keywords = "Cardiac arrest, Interposed abdominal compression CPR, Resuscitation, Ventricular fibrillation",
author = "Lyndon Xavier and Kern, {Karl B} and Berg, {Robert A.} and Hilwig, {Ronald W.} and Ewy, {Gordon A.}",
year = "2003",
month = "12",
doi = "10.1016/S0300-9572(03)00243-0",
language = "English (US)",
volume = "59",
pages = "337--344",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",
number = "3",

}

TY - JOUR

T1 - Comparison of standard CPR versus diffuse and stacked hand position interposed abdominal compression-CPR in a swine model

AU - Xavier, Lyndon

AU - Kern, Karl B

AU - Berg, Robert A.

AU - Hilwig, Ronald W.

AU - Ewy, Gordon A.

PY - 2003/12

Y1 - 2003/12

N2 - Interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) is an innovative basic life support technique requiring no mechanical adjuncts. Optimizing its performance remains a challenge. Hand-position technique over the abdomen during interposed abdominal compression (IAC) may be important. The purpose of this study was to determine if there is a difference in efficacy depending on the type of abdominal hand-position used. Two different hand positions were studied: open hands, placed side by side, resulting in diffuse abdominal compression and stacked hands, with one on top of the other, producing a more focal compression of the abdomen. Thirty swine were cannulated with micromanometer-tipped pressure transducers in the ascending aorta (Ao) and right atrium (RA), and Millar Doppler-tipped catheters in the descending aorta and inferior vena cava (IVC) to determine flow patterns during cardiopulmonary resuscitation (CPR), During CPR there were no differences in aortic systolic or right atrial systolic pressures. Both forms of IAC-CPR produced greater aortic diastolic and right atrial diastolic pressures then standard CPR (STD-CPR) (P<0.05). Coronary perfusion pressures (CPP), however, were not different. Blood flow directions and velocity patterns showed that STD-CPR chest compressions produce caudally directed blood flow in both the descending aorta and the IVC, and that such flows reverse (becoming cranially directed) during the relaxation phase of chest compression. IAC-CPR produced similar blood flow patterns in the aorta and IVC, as seen with STD-CPR. There were no differences in blood flow patterns between the different forms of IAC-CPR. No CPR-produced trauma difference was found. Abdominal hand position (diffuse or stacked) did not affect blood flow in either the aorta or IVC or resuscitation success in this experimental model. There was a trend towards better outcomes with stacked hands IAC-CPR with 90 versus 70% survival with STD-CPR.

AB - Interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) is an innovative basic life support technique requiring no mechanical adjuncts. Optimizing its performance remains a challenge. Hand-position technique over the abdomen during interposed abdominal compression (IAC) may be important. The purpose of this study was to determine if there is a difference in efficacy depending on the type of abdominal hand-position used. Two different hand positions were studied: open hands, placed side by side, resulting in diffuse abdominal compression and stacked hands, with one on top of the other, producing a more focal compression of the abdomen. Thirty swine were cannulated with micromanometer-tipped pressure transducers in the ascending aorta (Ao) and right atrium (RA), and Millar Doppler-tipped catheters in the descending aorta and inferior vena cava (IVC) to determine flow patterns during cardiopulmonary resuscitation (CPR), During CPR there were no differences in aortic systolic or right atrial systolic pressures. Both forms of IAC-CPR produced greater aortic diastolic and right atrial diastolic pressures then standard CPR (STD-CPR) (P<0.05). Coronary perfusion pressures (CPP), however, were not different. Blood flow directions and velocity patterns showed that STD-CPR chest compressions produce caudally directed blood flow in both the descending aorta and the IVC, and that such flows reverse (becoming cranially directed) during the relaxation phase of chest compression. IAC-CPR produced similar blood flow patterns in the aorta and IVC, as seen with STD-CPR. There were no differences in blood flow patterns between the different forms of IAC-CPR. No CPR-produced trauma difference was found. Abdominal hand position (diffuse or stacked) did not affect blood flow in either the aorta or IVC or resuscitation success in this experimental model. There was a trend towards better outcomes with stacked hands IAC-CPR with 90 versus 70% survival with STD-CPR.

KW - Cardiac arrest

KW - Interposed abdominal compression CPR

KW - Resuscitation

KW - Ventricular fibrillation

UR - http://www.scopus.com/inward/record.url?scp=0344628533&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0344628533&partnerID=8YFLogxK

U2 - 10.1016/S0300-9572(03)00243-0

DO - 10.1016/S0300-9572(03)00243-0

M3 - Article

VL - 59

SP - 337

EP - 344

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

IS - 3

ER -