Circulation, Vol 67, 266-275, Copyright © 1983 by American Heart Association
RC Koehler, N Chandra, AD Guerci, J Tsitlik, RJ Traystman, MC Rogers and ML Weisfeldt
Recent studies have demonstrated that for the same chest compression force
during mechanical cardiopulmonary resuscitation (CPR), the carotid
artery-to-jugular vein pressure gradient and carotid blood flow are
increased when the phasic rise of intrathoracic pressure is enhanced by
abdominal binding and simultaneous ventilation at high airway pressure with
each chest compression (SCV). The objective of the present study was to
assess whether cerebral blood flow is also enhanced, since it is known that
fluctuations in intrathoracic pressure are transmitted to the intracranial
space and affect intracranial pressure (ICP). In two series of
pentobarbital-anesthetized dogs, one of two CPR techniques was initiated
immediately after inducing ventricular fibrillation. Brain blood flow was
measured by the radiolabeled microsphere technique immediately before
cardiac arrest and at 1 and 3 minutes after commencing CPR. Evidence of
adequate mixing of spheres and lack of sedimentation under these low-flow
conditions was verified by correlation with brain venous outflow,
comparison of the arterial concentration-time profile of spheres and a
nonsedimentary marker (thallium-201 in solution), and use of multiple
arterial sampling sites. During SCV CPR with abdominal binding, mean
carotid artery pressure (60 +/- 3 mm Hg) was higher than that during
conventional CPR (25 +/- 2 mm HG). Pulsations of ICP occurred that were in
phase with chest compression and greater than jugular venous pressure. Mean
ICP was higher during SCV (46 +/- 2 mm Hg) than conventional CPR (20 +/- 2
mm Hg). However, the net brain perfusion pressure gradient (carotid artery
pressure - ICP) was greater with SCV (14 +/- 3 mm Hg) than with
conventional CPR (5 +/- 0.4 mm Hg). Cerebral blood flow was significantly
greater during SCV CPR (32 +/- 7% of prearrest cerebral flow) than during
conventional CPR (3 +/- 2%). We conclude that SCV CPR combined with
abdominal binding substantially improved brain perfusion by enhancing
cerebral perfusion pressure in this experimental model.
ARTICLES
Augmentation of cerebral perfusion by simultaneous chest compression and lung inflation with abdominal binding after cardiac arrest in dogs
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