The effect of applied chest compression force on systemic arterial pressure and endtidal carbon dioxide concentration during CPR in human beings

doi:10.1016/S0196-0644(89)80005-8

Annals of Emergency Medicine

Volume 18, Issue 7, July 1989, Pages 732-737

https://doi.org/10.1016/S0196-0644(89)80005-8 Get rights and content

Twelve adult (nine men and three women) cardiac arrest patients were studied as they received CPR by a computerized Thumper^® to determine the influence of the applied chest compression force on blood flow (as assessed by the end-tidal carbon dioxide concentration) and arterial pressure. At the end of a resuscitation when the decision was made by the senior physician to cease resuscitative efforts, the applied force on the CPR Thumper^® was decreased from 140 to 0 pound-force (lb_ƒ) in 20-lb_ƒ increments at 30-second intervals. Radial artery cutdown blood pressure and end-tidal carbon dioxide (ETCO₂) were recorded continuously. Arterial stystolic blood pressure was linearly related (r = .59, P < .0001) to applied force (systolic blood pressure, 31 ± 6 mm Hg at 20 lb_ƒ to 60 ± 7 mm Hg at 140 lb_ƒ). ETCO₂ (r = .42, P < .0001) was also linearly related to applied force (ETCO₂, 0.7 ± 0.1% at 20 lb_ƒ to 1.5 ± 0.2% at 140 lb_ƒ). Diastolic pressure did not change significantly with change in applied force (17 ± 2 mm Hg from 20 to 140 lb_ƒ). Our findings indicate that higher compression force than that currently recommended may improve arterial systolic pressure and flow in human beings receiving closed-chest compression during CPR.

References (32)

MacKenzieGJ et al.
Hemodynamic effects of external cardiac compression
Lancet
(1964)
ChandraN et al.
Simultaneous chest compression and ventilation at high airway pressure during cardiopulmonary resuscitation
Lancet
(1980)
NiemannJT et al.
Hemodynamic effects of continuous abdominal binding during cardiac arrest and resuscitation
Am J Cardiol
(1984)
BabbsCF et al.
Relationship of blood pressure and flow during CPR to chest compression amplitude: Evidence for an effective compression threshold
Ann Emerg Med
(1983)
SandersAB et al.
Expired pCO₂ as a prognostic indicator of successful resuscitation from cardiac arrest
Ann Emerg Med
(1985)
Del GuercioLRM et al.
Cardiac output and other hemodynamic variables during external cardiac massage in man
N Engl J Med
(1963)
Del GuercioLRM et al.
Comparison of blood flow during external and internal cardiac massage in man
Circulation
(1965)
RosboroughJP et al.
Lower abdominal compression with synchronized ventilation: A CPR modality
Circulation
(1981)
BircherN et al.
A comparison of standard “MAST”-augmented, and open-chest CPR in dogs: A preliminary investigation
Crit Care Med
(1980)
RalstonSH et al.
Cardiopulmonary resuscitation with interposed abdominal compression in dogs
Anesth Analg
(1982)

MaierGW et al.

The physiology of external cardiac massage: High-impulse cardiopulmonary resuscitation

Circulation

(1984)

American Heart Association

Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC)

JAMA

(1986)

BabbsCF

New versus old theories of blood flow during CPR

Crit Care Med

(1980)

NiemannJT et al.

The mechanism of blood flow in closed chest cardiopulmonary resuscitation

Circulation

(1979)

RudikoffMT et al.

Mechanisms of blood flow during cardiopulmonary resuscitation

Circulation

(1980)

Cited by (101)

Relationship Between Left Ventricle Position and Haemodynamic Parameters During Cardiopulmonary Resuscitation in a Pig Model
2018, Heart Lung and Circulation
From the viewpoint of cardiac pump theory, the area of the left ventricle (LV) subjected to compression increases as the LV lies closer to the sternum, possibly resulting in higher blood flow in patients with LV closer to the sternum. However, no study has evaluated LV position during cardiac arrest or its relationship with haemodynamic parameters during cardiopulmonary resuscitation (CPR). The objectives of this study were to determine whether the position of the LV relative to the anterior-posterior axis representing the direction of chest compression shifts during cardiac arrest and to examine the relationship between LV position and haemodynamic parameters during CPR.
Subcostal view echocardiograms were obtained from 15 pigs with the transducer parallel to the long axis of the sternum before inducing ventricular fibrillation (VF) and during cardiac arrest. Computed tomography was performed in three pigs to objectively observe LV position during cardiac arrest. LV position parameters including the shortest distance between the anterior-posterior axis and the mid-point of the LV chamber (D_AP-MidLV), the shortest distance between the anterior-posterior axis and the LV apex (D_AP-Apex), and the area fraction of the LV located on the right side of the anterior-posterior axis (LVA_Right/LVA_Total) were measured.
D_AP-MidLV, D_AP-Apex, and LVA_Right/LVA_Total decreased progressively during untreated VF and basic life support (BLS), and then increased during advanced cardiovascular life support (ACLS). A repeated measures analysis of variance revealed significant time effects for these parameters. During BLS, the end-tidal carbon dioxide and systolic right atrial pressure were significantly correlated with the LV position parameters. During ACLS, systolic arterial pressure and systolic right atrial pressure were significantly correlated with D_AP-MidLV and D_AP-Apex.
Left ventricular position changed significantly during cardiac arrest compared to the pre-arrest baseline. LV position during CPR had significant correlations with haemodynamic parameters.
Chest compression rates and pediatric in-hospital cardiac arrest survival outcomes
2018, Resuscitation
The primary aim of this study was to evaluate the association between chest compression rates and 1) arterial blood pressure and 2) survival outcomes during pediatric in-hospital cardiopulmonary resuscitation (CPR).
Prospective observational study of children ≥37 weeks gestation and <19 years old who received CPR in an intensive care unit (ICU) as part of the Pediatric Intensive Care Unit Quality of CPR Study (PICqCPR) of the Collaborative Pediatric Critical Care Research Network (CPCCRN). Arterial blood pressure and compression rate were determined from manually extracted arterial line waveform data during the first 10 min of CPR. The primary outcome was survival to hospital discharge. Modified Poisson regression models assessed the association between rate categories (80–<100, 100–120 [Guidelines], >120–140, >140) and outcomes.
Compression rate data were available for 164 patients. More than half (98/164; 60%) were <1 year old. Return of circulation was achieved in 148/164 (90%); survival to hospital discharge in 77/164 (47%). Percentage of events with average rate within Guidelines was 32.9%. Compared to Guidelines, higher rate categories were associated with lower systolic blood pressures (>120–140, p = 0.010; >140, p = 0.077), but not survival. A rate between 80-<100 per minute was associated with a higher rate of survival to hospital discharge (aRR 1.92, CI95 1.13, 3.29, p = 0.017) and survival with favorable neurological outcome (aRR 2.12, CI95 1.09, 4.13, p = 0.027) compared to Guidelines.
Non-compliance with compression rate Guidelines was common in this multicenter cohort. Among ICU patients, slightly lower rates were associated with improved outcomes compared to Guidelines.
Complete chest recoil during laypersons' CPR: Is it a matter of weight?
2017, American Journal of Emergency Medicine
Chest compressions depth and complete chest recoil are both important for high-quality Cardio-Pulmonary Resuscitation (CPR). It has been demonstrated that anthropometric variables affect chest compression depth, but there are no data about they could influence chest recoil. The aim of this study was to verify whether physical attributes influences chest recoil in lay rescuers.
We evaluated 1 minute of compression-only CPR performed by 333 laypersons immediately after a Basic Life Support and Automated External Defibrillation (BLS/AED) course. The primary endpoint was to verify whether anthropometric variables influence the achievement a complete chest recoil. Secondary endpoint was to verify the influence of anthropometric variables on chest compression depth.
We found a statistically significant association between weight and percentage of compressions with correct release (p ≤ 0.001) and this association was found also for height, BMI and sex. People who are heavier, who are taller, who have a greater BMI and who are male are less likely to achieve a complete chest recoil. Regarding chest compressions depth, we confirm that the more a person weighs, the more likely the correct depth of chest compressions will be reached.
Anthropometric variables affect not only chest compression depth, but also complete chest recoil. CPR instructors should tailor their attention during training on different aspect of chest compression depending on the physical characteristics of the attendee.
Emergency monitoring
2016, Journal Europeen des Urgences et de Reanimation
Le monitorage correspond à un ensemble de techniques consistant à surveiller, de manière continue ou discontinue, différents paramètres en complément de l’examen clinique. Son intérêt en termes d’amélioration du pronostic n’est plus à démontrer. Le contexte de l’urgence impose un cahier des charges simple mais strict. Le monitorage peut concerner des paramètres cliniques, biologiques et/ou iconographiques. Un monitorage « ciblé et adapté » au contexte est à privilégier par rapport à un monitorage « multiple et systématique ». Le monitorage vient en complément de la surveillance clinique, mais ne dispense pas de celle-ci.
Comparison of team-focused CPR vs standard CPR in resuscitation from out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative
2016, Resuscitation
Citation Excerpt :
Minimally interrupted chest compressions and early defibrillation have been associated with good neurological outcomes among OHCA survivors.2 Similar benefit has not been attributed to advanced airway management or administration of ACLS medications.3–9 Team-focused CPR (TFCPR) (also known as high-performance CPR or “pitcrew” CPR) is a choreographed approach to CPR where pre-hospital responders know and practice their role in resuscitation in order to focus on evidence-based strategies to improve CPR performance quality.
Team-focused CPR (TFCPR) is a choreographed approach to cardiopulmonary resuscitation (CPR) with emphasis on minimally interrupted high-quality chest compressions, early defibrillation, discourages endotracheal intubation and encourages use of the bag-valve-mask (BVM) and/or blind-insertion airway device (BIAD) with a ventilation rate of 8–10 breaths/min to minimize hyperventilation. Widespread incorporation of TFCPR in North Carolina (NC) EMS agencies began in 2011, yet its impact on outcomes is unknown.
To determine whether TFCPR improves survival with good neurological outcome in out-of-hospital cardiac arrest (OHCA) patients compared to standard CPR.
This retrospective cohort analysis of NC EMS agencies reporting data to the Cardiac Arrest Registry for Enhanced Survival (CARES) database from January 2010 to June 2014 included adult, non-traumatic OHCA with presumed cardiac etiology where EMS performed CPR or patient received defibrillation. Exclusions were arrest terminated per EMS policy or DNR. EMS agencies self-reported the TFCPR implementation dates. Patients were categorized as receiving either TFCPR or standard CPR. The primary outcome was good neurologic outcome at time of hospital discharge defined as Pittsburgh Cerebral Performance Category (CPC) 1–2.
Of 14,994 OHCAs, 14,129 patients were included for analysis with a mean age 65 (IQR 50–81) years, 61% male, 7.3% with good neurologic outcome, 24.3% with shockable initial rhythm, and 71.5% receiving TFCPR. Of the 3427 (24.3%) with an initial shockable rhythm, 739 (71.9%) had a good neurological outcome. Good neurologic outcome was higher with TFCPR [836 (8.3%, 95%CI 7.7–8.8%)] vs. standard CPR [193 (4.8%, 95%CI 4.2–5.5%)]. Logistic regression controlling for demographic and arrest characteristics revealed TFCPR (OR 1.5), witnessed arrest (OR 4.3), initial shockable rhythm (OR 7.1), and in-hospital hypothermia (OR 3.3) were associated with good neurologic outcome. Mechanical CPR device (OR 0.68), CPR feedback device (OR 0.47), and endotracheal intubation (OR 0.44) were associated with less likelihood for a good neurologic outcome.
In our statewide OHCA cohort, TFCPR was associated with improved survival with good neurological outcome.
Are the current guideline recommendations for neonatal cardiopulmonary resuscitation safe and effective?
2016, American Journal of Emergency Medicine
A recently published review of approaches to optimize chest compressions in the resuscitation of asphyxiated newborns discussed the current recommendations and explored potential determinants of effective neonatal cardiopulmonary resuscitation (CPR). However, not all potential determinants of effective neonatal CPR were explored. Chest compression shallower than the current guideline recommendation of approximately 33% of the anterior-posterior (AP) chest diameter may be safer and more effective. From a physiological standpoint, high-velocity brief duration shallower compression may be more effective than current recommendations. The application of a 1- or 2-finger method of high-impulse CPR, which would depend on the size of the subject, may be more effective than using a 2-thumb (TT) encircling hands method of CPR. Adrenaline should not be used in the treatment of asphyxiated neonates and when necessary titrated vasopressin should be used.

View all citing articles on Scopus

View full text

Original contributionThe effect of applied chest compression force on systemic arterial pressure and endtidal carbon dioxide concentration during CPR in human beings

Lancet

Lancet

Am J Cardiol

Ann Emerg Med

Ann Emerg Med

Cardiac output and other hemodynamic variables during external cardiac massage in man

N Engl J Med

Comparison of blood flow during external and internal cardiac massage in man

Circulation

Lower abdominal compression with synchronized ventilation: A CPR modality

Circulation

A comparison of standard “MAST”-augmented, and open-chest CPR in dogs: A preliminary investigation

Crit Care Med

Cardiopulmonary resuscitation with interposed abdominal compression in dogs

Anesth Analg

The physiology of external cardiac massage: High-impulse cardiopulmonary resuscitation

Circulation

Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC)

JAMA

New versus old theories of blood flow during CPR

Crit Care Med

The mechanism of blood flow in closed chest cardiopulmonary resuscitation

Circulation

Mechanisms of blood flow during cardiopulmonary resuscitation

Circulation

Original contribution
The effect of applied chest compression force on systemic arterial pressure and endtidal carbon dioxide concentration during CPR in human beings