Circulation, Vol 73, 539-550, Copyright © 1986 by American Heart Association
HR Halperin, JE Tsitlik, AD Guerci, ED Mellits, HR Levin, AY Shi, N Chandra and ML Weisfeldt
Whether blood flow during cardiopulmonary resuscitation (CPR) results from
intrathoracic pressure fluctuations or direct cardiac compression remains
controversial. From modeling considerations, blood flow due to
intrathoracic pressure fluctuations should be insensitive to compression
rate over a wide range, but dependent on the applied force and compression
duration. If direct compression of the heart plays a major role, however,
flow should be dependent on compression rate and force, but above a
threshold, insensitive to compression duration. These differences in
hemodynamics produced by changes in rate and duration form a basis for
determining whether blood flow during CPR results from intrathoracic
pressure fluctuations or from direct cardiac compression. Manual CPR was
studied in eight anesthetized, 21 to 32 kg dogs after induction of
ventricular fibrillation. There was no surgical manipulation of the chest.
Myocardial and cerebral blood flows were determined with radioactive
microspheres. At nearly constant peak sternal force (378 to 426 newtons),
flow was significantly increased when the duration of compression was
increased from 14 +/- 1% to 46 +/- 3% of the cycle at a rate of 60/min.
Flow was unchanged, however, after an increase in rate from 60 to 150/min
at constant compression duration. The hemodynamics of manual CPR were next
compared with those produced by vest inflation with simultaneous
ventilation (vest CPR) in eight other dogs. Vest CPR changed intrathoracic
pressure without direct cardiac compression, since sternal displacement was
less than 0.8 cm. At a rate of 150/min, with similar duration and right
atrial peak pressure, manual and vest CPR produced similar flow and
perfusion pressures. Finally, the hemodynamics of manual CPR were compared
with the hemodynamics of direct cardiac compression after thoracotomy.
Cardiac deformation was measured and held nearly constant during changes in
rate and duration. As opposed to changes accompanying manual CPR, there was
no change in perfusion pressures when duration was increased from 15% to
45% of the cycle at a constant rate of 60/min. There was, however, a
significant increase in perfusion pressures when rate was increased from 60
to 150/min at a constant duration of 45%. Thus, vital organ perfusion
pressures and flow during manual external chest compression are dependent
on the duration of compression, but not on rates of 60 or 150/min. These
data are similar to those observed for vest CPR, where intrathoracic
pressure is manipulated without sternal displacement, but opposite of those
observed for direct cardiac compression.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Determinants of blood flow to vital organs during cardiopulmonary resuscitation in dogs
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