Circulation, Vol 66, 297-302, Copyright © 1982 by American Heart Association
RV Ditchey, JV Winkler and CA Rhodes
Recent studies have shown that blood flow during closed-chest
cardiopulmonary resuscitation (CPR) results primarily from generalized
changes in intrathoracic pressure rather than direct compression of the
heart. Since ascending aortic and right atrial pressures rise and fall
synchronously and to comparable levels during CPR, we hypothesized that the
absence of a pressure difference across the coronary vascular bed during
CPR precludes coronary blood flow. To test this hypothesis, we compared
high-fidelity ascending aortic and right atrial pressures and carotid and
coronary blood flow (electromagnetic flowmeters) during closed-chest CPR in
12 fibrillating dogs. Chest compression force was increased from 40 to 140
pounds in 20-pound increments using a pneumatic chest compression device.
Although ascending aortic and right atrial pressures were always similar,
high-compression-force CPR produced small mean pressure differences across
the coronary vascular bed (5.6 +/- 0.8 mm Hg [+/- SEM] at 140 pounds).
These pressure differences were accompanied by low levels of coronary blood
flow. However, coronary flow was less than 1% control (prearrest) values
whenever chest compression force was less than 100 pounds, and carotid flow
exceeded coronary flow under all conditions (carotid and coronary flows at
140 pounds = 26.2 +/- 6.4% and 4.3 +/- 2.0% of prearrest values,
respectively, p less than 0.01). We conclude that generalized changes in
intrathoracic vascular pressures during closed-chest CPR promote carotid
but not coronary blood flow. High-compression-force CPR produces small
pressure differences across the coronary vascular bed, allowing low levels
of coronary flow. However, even high-compression- force CPR is over six
times more effective in maintaining carotid flow than coronary flow.
ARTICLES
Relative lack of coronary blood flow during closed-chest resuscitation in dogs
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