Leaning during chest compressions impairs cardiac output and left ventricular myocardial blood flow in piglet cardiac arrest

Mathias Zuercher, Ronald W. Hilwig, James Ranger-Moore, Jon Nysaether, Vinay M. Nadkarni, Marc D Berg, Karl B Kern, Robert Sutton, Robert A. Berg

Research output: Contribution to journalArticle

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Abstract

Objective: Complete recoil of the chest wall between chest compressions during cardiopulmonary resuscitation is recommended, because incomplete chest wall recoil from leaning may decrease venous return and thereby decrease blood flow. We evaluated the hemodynamic effect of 10% or 20% lean during piglet cardiopulmonary resuscitation. Design: Prospective, sequential, controlled experimental animal investigation. Setting: University research laboratory. Subjects: Domestic piglets. Interventions: After induction of ventricular fibrillation, cardiopulmonary resuscitation was provided to ten piglets (10.7 ± 1.2 kg) for 18 mins as six 3-min epochs with no lean, 10% lean, or 20% lean to maintain aortic systolic pressure of 80-90 mm Hg. Because the mean force to attain 80-90 mm Hg was 18 kg in preliminary studies, the equivalent of 10% and 20% lean was provided by use of 1.8-and 3.6-kg weights on the chest. Measurements and Main Results: Using a linear mixed-effect regression model to control for changes in cardiopulmonary resuscitation hemodynamics over time, mean right atrial diastolic pressure was 9 ± 0.6 mm Hg with no lean, 10 ± 0.3 mm Hg with 10% lean (p <.01), and 13 ± 0.3 mm Hg with 20% lean (p <.01), resulting in decreased coronary perfusion pressure with leaning. Microsphere-determined cardiac index and left ventricular myocardial blood flow were lower with 10% and 20% leaning throughout the 18 mins of cardiopulmonary resuscitation. Mean cardiac index decreased from 1.9 ± 0.2 L • M-2 • min-1 with no leaning to 1.6 ± 0.1 L • M-2 • min with 10% leaning, and 1.4 ± 0.2 L • M-2 • min-1 with 20% leaning (p <.05). The myocardial blood flow decreased from 39 ± 7 mL • min-1 • 100 g with no lean to 30 ± 6 mL • min -1 • 100 g with 10% leaning and 26 ± 6 mL • min -1 • 100 g with 20% leaning (p <.05). Conclusions: Leaning of 10% to 20% (i.e., 1.8-3.6 kg) during cardiopulmonary resuscitation substantially decreased coronary perfusion pressure, cardiac index, and myocardial blood flow.

Original languageEnglish (US)
Pages (from-to)1141-1146
Number of pages6
JournalCritical Care Medicine
Volume38
Issue number4
DOIs
StatePublished - Apr 2010

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Cardiopulmonary Resuscitation
Heart Arrest
Cardiac Output
Thorax
Thoracic Wall
Perfusion
Hemodynamics
Blood Pressure
Pressure
Atrial Pressure
Ventricular Fibrillation
Microspheres
Arterial Pressure
Weights and Measures
Research

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Cardiopulmonary resuscitation quality
  • Chest compressions
  • Leaning
  • Pediatric

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Leaning during chest compressions impairs cardiac output and left ventricular myocardial blood flow in piglet cardiac arrest. / Zuercher, Mathias; Hilwig, Ronald W.; Ranger-Moore, James; Nysaether, Jon; Nadkarni, Vinay M.; Berg, Marc D; Kern, Karl B; Sutton, Robert; Berg, Robert A.

In: Critical Care Medicine, Vol. 38, No. 4, 04.2010, p. 1141-1146.

Research output: Contribution to journalArticle

Zuercher, Mathias ; Hilwig, Ronald W. ; Ranger-Moore, James ; Nysaether, Jon ; Nadkarni, Vinay M. ; Berg, Marc D ; Kern, Karl B ; Sutton, Robert ; Berg, Robert A. / Leaning during chest compressions impairs cardiac output and left ventricular myocardial blood flow in piglet cardiac arrest. In: Critical Care Medicine. 2010 ; Vol. 38, No. 4. pp. 1141-1146.
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AU - Hilwig, Ronald W.

AU - Ranger-Moore, James

AU - Nysaether, Jon

AU - Nadkarni, Vinay M.

AU - Berg, Marc D

AU - Kern, Karl B

AU - Sutton, Robert

AU - Berg, Robert A.

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N2 - Objective: Complete recoil of the chest wall between chest compressions during cardiopulmonary resuscitation is recommended, because incomplete chest wall recoil from leaning may decrease venous return and thereby decrease blood flow. We evaluated the hemodynamic effect of 10% or 20% lean during piglet cardiopulmonary resuscitation. Design: Prospective, sequential, controlled experimental animal investigation. Setting: University research laboratory. Subjects: Domestic piglets. Interventions: After induction of ventricular fibrillation, cardiopulmonary resuscitation was provided to ten piglets (10.7 ± 1.2 kg) for 18 mins as six 3-min epochs with no lean, 10% lean, or 20% lean to maintain aortic systolic pressure of 80-90 mm Hg. Because the mean force to attain 80-90 mm Hg was 18 kg in preliminary studies, the equivalent of 10% and 20% lean was provided by use of 1.8-and 3.6-kg weights on the chest. Measurements and Main Results: Using a linear mixed-effect regression model to control for changes in cardiopulmonary resuscitation hemodynamics over time, mean right atrial diastolic pressure was 9 ± 0.6 mm Hg with no lean, 10 ± 0.3 mm Hg with 10% lean (p <.01), and 13 ± 0.3 mm Hg with 20% lean (p <.01), resulting in decreased coronary perfusion pressure with leaning. Microsphere-determined cardiac index and left ventricular myocardial blood flow were lower with 10% and 20% leaning throughout the 18 mins of cardiopulmonary resuscitation. Mean cardiac index decreased from 1.9 ± 0.2 L • M-2 • min-1 with no leaning to 1.6 ± 0.1 L • M-2 • min with 10% leaning, and 1.4 ± 0.2 L • M-2 • min-1 with 20% leaning (p <.05). The myocardial blood flow decreased from 39 ± 7 mL • min-1 • 100 g with no lean to 30 ± 6 mL • min -1 • 100 g with 10% leaning and 26 ± 6 mL • min -1 • 100 g with 20% leaning (p <.05). Conclusions: Leaning of 10% to 20% (i.e., 1.8-3.6 kg) during cardiopulmonary resuscitation substantially decreased coronary perfusion pressure, cardiac index, and myocardial blood flow.

AB - Objective: Complete recoil of the chest wall between chest compressions during cardiopulmonary resuscitation is recommended, because incomplete chest wall recoil from leaning may decrease venous return and thereby decrease blood flow. We evaluated the hemodynamic effect of 10% or 20% lean during piglet cardiopulmonary resuscitation. Design: Prospective, sequential, controlled experimental animal investigation. Setting: University research laboratory. Subjects: Domestic piglets. Interventions: After induction of ventricular fibrillation, cardiopulmonary resuscitation was provided to ten piglets (10.7 ± 1.2 kg) for 18 mins as six 3-min epochs with no lean, 10% lean, or 20% lean to maintain aortic systolic pressure of 80-90 mm Hg. Because the mean force to attain 80-90 mm Hg was 18 kg in preliminary studies, the equivalent of 10% and 20% lean was provided by use of 1.8-and 3.6-kg weights on the chest. Measurements and Main Results: Using a linear mixed-effect regression model to control for changes in cardiopulmonary resuscitation hemodynamics over time, mean right atrial diastolic pressure was 9 ± 0.6 mm Hg with no lean, 10 ± 0.3 mm Hg with 10% lean (p <.01), and 13 ± 0.3 mm Hg with 20% lean (p <.01), resulting in decreased coronary perfusion pressure with leaning. Microsphere-determined cardiac index and left ventricular myocardial blood flow were lower with 10% and 20% leaning throughout the 18 mins of cardiopulmonary resuscitation. Mean cardiac index decreased from 1.9 ± 0.2 L • M-2 • min-1 with no leaning to 1.6 ± 0.1 L • M-2 • min with 10% leaning, and 1.4 ± 0.2 L • M-2 • min-1 with 20% leaning (p <.05). The myocardial blood flow decreased from 39 ± 7 mL • min-1 • 100 g with no lean to 30 ± 6 mL • min -1 • 100 g with 10% leaning and 26 ± 6 mL • min -1 • 100 g with 20% leaning (p <.05). Conclusions: Leaning of 10% to 20% (i.e., 1.8-3.6 kg) during cardiopulmonary resuscitation substantially decreased coronary perfusion pressure, cardiac index, and myocardial blood flow.

KW - Cardiac arrest

KW - Cardiopulmonary resuscitation

KW - Cardiopulmonary resuscitation quality

KW - Chest compressions

KW - Leaning

KW - Pediatric

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