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Salcido DD, Koller AC, Genbrugge C, Fink EL, Berg RA, Menegazzi JJ. Injury characteristics and hemodynamics associated with guideline-compliant CPR in a pediatric porcine cardiac arrest model. Am J Emerg Med 2022; 51:176-183. [PMID: 34763236 PMCID: PMC8982633 DOI: 10.1016/j.ajem.2021.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/08/2021] [Accepted: 10/16/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Guidelines for depth of chest compressions in pediatric cardiopulmonary resuscitation (CPR) are based on sparse evidence. OBJECTIVE We sought to evaluate the performance of the two most widely recommended chest compression depth levels for pediatric CPR (1.5 in. and 1/3 the anterior-posterior diameter- APd) in a controlled swine model of asphyxial cardiac arrest. METHODS We executed a 2-group, randomized laboratory study with an adaptive design allowing early termination for overwhelming injury or benefit. Forty mixed-breed domestic swine (mean weight = 26 kg) were sedated, anesthetized and paralyzed along with endotracheal intubation and mechanical ventilation. Asphyxial cardiac arrest was induced with fentanyl overdose. Animals were untreated for 9 min followed by mechanical CPR with a target depth of 1.5 in. or 1/3 the APd. Advanced life support drugs were administered IV after 4 min of basic resuscitation followed by defibrillation at 14 min. The primary outcomes were return of spontaneous circulation (ROSC), hemodynamics and CPR-related injury severity. RESULTS Enrollment in the 1/3 APd group was stopped early due to overwhelming differences in injury. Twenty-three animals were assigned to the 1.5 in. group and 15 assigned to the 1/3 APd group, per an adaptive group design. The 1/3 APd group had increased frequency of rib fracture (6.7 vs 1.7, p < 0.001) and higher proportions of several anatomic injury markers than the 1.5 in. group, including sternal fracture, hemothorax and blood in the endotracheal tube (p < 0.001). ROSC and hemodynamic measures were similar between groups. CONCLUSION In this pediatric model of cardiac arrest, chest compressions to 1/3APd were more harmful without a concurrent benefit for resuscitation outcomes compared to the 1.5 in. compression group.
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Affiliation(s)
- David D. Salcido
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Allison C. Koller
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Ericka L. Fink
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Robert A. Berg
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Liang L, Li Z, Chen R, Liu S, Zhou T, Jiang L, Tang W, Jiang J, Yang Z. Compression depth of 30 mm has similar efficacy and fewer complications versus 50 mm during mechanical chest compression with miniaturized chest compressor in a porcine model of cardiac arrest. J Thorac Dis 2021; 13:5788-5798. [PMID: 34795927 PMCID: PMC8575856 DOI: 10.21037/jtd-21-812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/09/2021] [Indexed: 12/04/2022]
Abstract
Background Current guidelines recommend a 50 mm or greater compression depth for manual chest compression in adults. However, whether this uniform compression depth is a suitable requirement for mechanical CPR remains to be determined. We hypothesized that a relatively shallow compression depth (30 mm) would have similar hemodynamic efficacy but fewer complications versus the standard compression depth (50 mm) during mechanical cardiopulmonary resuscitation (CPR) with the miniaturized chest compressor (MCC) in a porcine model. Methods In the current study, we used a total of 16 domestic male pigs (38±2 kg). All pigs were exposed to 7 min of ventricular fibrillation (VF) followed by 5 min of CPR. Then the animals were randomly assigned to the shallow (30 mm) group and the standard (50 mm) group. At the second min of CPR, every pig was given epinephrine (20 µg/kg) through the femoral vein and repeated every 3 min. First defibrillation was delivered with a single 120 J shock at 5 min of CPR. Hemodynamics, carotid blood flow (CBF), end-tidal carbon dioxide (ETCO2), coronary perfusion pressure (CPP), intrathoracic pressure (ITP) and arterial blood gas were measured. Rib fractures and lung injuries, as indicated by ground-glass opacification (GGO), as well as intense parenchymal opacification (IPO), were assessed and calculated by quantitative computed tomography (QCT) scan. Results We found no significant differences in CPP, CBF, or ETCO2 between the both groups throughout the CPR period. After administration of epinephrine, the CPP of all animals increased while ETCO2 and CBF decreased during CPR. A significantly lower intrathoracic positive pressure (ITPP) and systolic artery pressure (SAP) were measured in the shallow group at the first min of CPR. However, we didn’t find remarkable differences in these values between the both groups for the next 4 min of CPR. All animals were successfully resuscitated. The shallow group had significantly lower IPO QCT scores compared with the standard group. We found no significant differences in GGO QCT scores after resuscitation between both groups. Conclusions Relatively shallow compression depth has similar hemodynamic efficacy but fewer complications versus the standard compression depth.
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Affiliation(s)
- Lian Liang
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zuyong Li
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ran Chen
- Department of Clinical Laboratory, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Siqi Liu
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tianen Zhou
- Department of Emergency, the First People's Hospital of Foshan, Foshan, China
| | - Longyuan Jiang
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wanchun Tang
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Jiang
- Department of Emergency, the First People's Hospital of Foshan, Foshan, China
| | - Zhengfei Yang
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Li H, Yang C, Yin Y, Wang F, Chen M, Xu L, Wang N, Zhang D, Wang X, Kong Y, Li Q, Su S, Cao Y, Liu W, Ao Z, Dai L, Ma C, Shang L, Han D, Ji F, Li H. An extravascular fluid transport system based on structural framework of fibrous connective tissues in human body. Cell Prolif 2019; 52:e12667. [PMID: 31373101 PMCID: PMC6797508 DOI: 10.1111/cpr.12667] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hongyi Li
- Beijing Hospital National Center of Gerontology Beijing China
| | - Chongqing Yang
- Beijing Hospital National Center of Gerontology Beijing China
| | - Yajun Yin
- Department of Engineering Mechanics Tsinghua University Beijing China
| | - Fang Wang
- Beijing Hospital National Center of Gerontology Beijing China
| | - Min Chen
- Beijing Hospital National Center of Gerontology Beijing China
| | - Liang Xu
- Beijing Hospital National Center of Gerontology Beijing China
| | - Naili Wang
- Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences Beijing China
- School of Basic Medicine Peking Union Medical College Beijing China
| | - Di Zhang
- Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences Beijing China
- School of Basic Medicine Peking Union Medical College Beijing China
| | - Xiaoxia Wang
- Beijing Hospital National Center of Gerontology Beijing China
| | - Yiya Kong
- Beijing Hospital National Center of Gerontology Beijing China
| | - Qing Li
- Beijing Hospital National Center of Gerontology Beijing China
| | - Si Su
- Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences Beijing China
- School of Basic Medicine Peking Union Medical College Beijing China
| | - Yupeng Cao
- National Center for Nanoscience and Technology Beijing China
| | - Wentao Liu
- National Center for Nanoscience and Technology Beijing China
| | - Zhuo Ao
- National Center for Nanoscience and Technology Beijing China
| | - Luru Dai
- National Center for Nanoscience and Technology Beijing China
| | - Chao Ma
- Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences Beijing China
- School of Basic Medicine Peking Union Medical College Beijing China
| | - Lijun Shang
- School of Chemistry and Biosciences University of Bradford Bradford UK
| | - Dong Han
- National Center for Nanoscience and Technology Beijing China
| | - Fusui Ji
- Beijing Hospital National Center of Gerontology Beijing China
| | - Hua Li
- Institute of Computing Technology Chinese Academy of Sciences Beijing China
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Qian A, Xu J, Wu C, Liu S, Zhang M. Hypothermia Inhibits Cerebral Necroptosis and NOD-Like Receptor Pyrin Domain Containing 3 Pathway in a Swine Model of Cardiac Arrest. J Surg Res 2019; 244:468-476. [PMID: 31330290 DOI: 10.1016/j.jss.2019.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 05/09/2019] [Accepted: 05/29/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Targeted temperature management (TTM) is commonly used in hypothermia after cardiopulmonary resuscitation (CPR), and its mechanism to improve cerebral function is complex. This study aimed to investigate the effects of TTM on necroptosis and the NOD-like receptor pyrin domain containing 3 (NLRP3) inflammasome in the brain tissue of pigs after CPR. MATERIALS AND METHODS Ventricular fibrillation was induced, and CPR was performed 10 min later in nine pigs in the normothermia group and nine pigs in the TTM group. The body temperature in the TTM group was dropped to 33°C after CPR and maintained for 24 h, whereas in the normothermia group, it was maintained at 38°C. Before CPR and at 30 h after CPR, serum neuron-specific enolase and S-100β were measured. At 30 h after CPR, pigs were euthanized, and brain tissues were collected for measurement of receptor-interacting protein kinase (RIPIK) 1, RIPK3, mixed lineage kinase domain-like (MLKL), NLRP3, cysteinyl aspartate-specific proteinase (caspase)-1, interleukin (IL)-1β, and IL-18. RESULTS Serum neuron-specific enolase and S-100β were increased significantly (P < 0.05) in the two CPR-treated groups compared with the sham group and more obviously in the normothermia group. In addition, the expression of RIPK3, phosphorylated MLKL, and NLRP3 in brain tissues was increased. The expression of RIPK3, phosphorylated MLKL, NLRP3, and caspase-1 as well as the levels of IL-1β and IL-18 were lower (P < 0.05) in the TTM group compared with the normothermia group. CONCLUSIONS Necroptosis and the NLRP3 pathway were activated after CPR. TTM may attenuate postresuscitation brain injury through the regulation of necroptosis and the NLRP3 pathway.
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Affiliation(s)
- Anyu Qian
- Department of Emergency Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jiefeng Xu
- Department of Emergency Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chunshuang Wu
- Department of Emergency Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shaoyun Liu
- Department of Emergency Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Mao Zhang
- Department of Emergency Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
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Yang Z, Liu Q, Zheng G, Liu Z, Jiang L, Lin Q, Chen R, Tang W. Comparison of continuous compression with regular ventilations versus 30:2 compressions-ventilations strategy during mechanical cardiopulmonary resuscitation in a porcine model of cardiac arrest. J Thorac Dis 2017; 9:3232-3238. [PMID: 29221300 DOI: 10.21037/jtd.2017.08.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A compression-ventilation (C:V) ratio of 30:2 is recommended for adult cardiopulmonary resuscitation (CPR) by the current American Heart Association (AHA) guidelines. However, continuous chest compression (CCC) is an alternative strategy for CPR that minimizes interruption especially when an advanced airway exists. In this study, we investigated the effects of 30:2 mechanical CPR when compared with CCC in combination with regular ventilation in a porcine model. Methods Sixteen male domestic pigs weighing 39±2 kg were utilized. Ventricular fibrillation was induced and untreated for 7 min. The animals were then randomly assigned to receive CCC combined with regular ventilation (CCC group) or 30:2 CPR (VC group). Mechanical chest compression was implemented with a miniaturized mechanical chest compressor. At the same time of beginning of precordial compression, the animals were mechanically ventilated at a rate of 10 breaths-per-minute in the CCC group or with a 30:2 C:V ratio in the VC group. Defibrillation was delivered by a single 150 J shock after 5 min of CPR. If failed to resuscitation, CPR was resumed for 2 min before the next shock. The protocol was stopped if successful resuscitation or at a total of 15 min. The resuscitated animals were observed for 72 h. Results Coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow in the VC group were similar to those achieved in the CCC group during CPR. No significant differences were observed in arterial blood gas parameters between two groups at baseline, VF 6 min, CPR 4 min and 30, 120 and 360 min post-resuscitation. Although extravascular lung water index of both groups significantly increased after resuscitation, no distinct difference was found between CCC and VC groups. All animals were successfully resuscitated and survived for 72 h with favorable neurologic outcomes in both groups. However, obviously more numbers of rib fracture were observed in CCC animals in comparison with VC animals. Conclusions There was no difference in hemodynamic efficacy and gas exchange during and after resuscitation, therefore identical 72 h survival with intact neurologic function was observed in both VC and CCC groups. However, the incidence of rib fracture increases during the mechanical CPR strategy of CCC combined with regular ventilations.
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Affiliation(s)
- Zhengfei Yang
- Zengcheng District People's Hospital of Guangzhou, Guangzhou 511300, China.,Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Weil Institute of Emergency and Critical Care Research, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Qingyu Liu
- Zengcheng District People's Hospital of Guangzhou, Guangzhou 511300, China.,Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Guanghui Zheng
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhifeng Liu
- Zengcheng District People's Hospital of Guangzhou, Guangzhou 511300, China
| | - Longyuan Jiang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Qing Lin
- Zengcheng District People's Hospital of Guangzhou, Guangzhou 511300, China
| | - Rui Chen
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Wanchun Tang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Weil Institute of Emergency and Critical Care Research, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
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Chen S, Li W, Zhang Z, Min H, Li H, Wang H, Zhuang Y, Chen Y, Gao C, Peng H. Evaluating the Quality of Cardiopulmonary Resuscitation in the Emergency Department by Real-Time Video Recording System. PLoS One 2015; 10:e0139825. [PMID: 26431420 PMCID: PMC4592189 DOI: 10.1371/journal.pone.0139825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/16/2015] [Indexed: 11/28/2022] Open
Abstract
Objectives To compare cardiopulmonary resuscitation (CPR) quality between manual CPR and miniaturized chest compressor (MCC) CPR. To improve CPR quality through evaluating the quality of our clinical work of resuscitation by real-time video recording system. Methods The study was a retrospective observational study of adult patients who experienced CPR at the emergency department of Shanghai Tenth People’s Hospital from March 2013 to August 2014. All the performance of CPR were checked back by the record of “digital real-time video recording system”. Average chest compression rate, actual chest compression rate, the percentage of hands-off period, time lag from patient arrival to chest compression, time lag from patient arrival to manual ventilation, time lag from patient arrival to first IV establish were compared. Causes of chest compression hands-off time were also studied. Results 112 cases of resuscitation attempts were obtained. Average chest compression rate was over 100 compression per minute (cpm) in the majority of cases. However, indicators such as percentage of hands-off periods, time lag from patient arrival to the first manual ventilation and time lag from patient arrival to the first IV establish seemed to be worse in the manual CPR group compared to MCC CPR group. The saving of operators change time seemed to counteract the time spent on MCC equipment. Indicators such as percentage of hands-off periods, time lag between patient arrival to the first chest compression, time lag between patient arrival to the first manual ventilation and time lag from patient arrival to the first IV establish may influence the survival. Conclusion Our CPR quality remained to be improved. MCC may have a potentially positive role in CPR.
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Affiliation(s)
- Sheng Chen
- Emergency Department, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Wenjie Li
- Emergency Department, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Zhonglin Zhang
- Emergency Department, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Hongye Min
- Nursing Department, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Hong Li
- Nursing Department, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Huiqi Wang
- Emergency Department, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yugang Zhuang
- Emergency Department, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yuanzhuo Chen
- Emergency Department, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
- * E-mail: (HP); (YZC)
| | - Chengjin Gao
- Emergency Department, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Hu Peng
- Emergency Department, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, China
- * E-mail: (HP); (YZC)
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Yang Z, Tang D, Wu X, Hu X, Xu J, Qian J, Yang M, Tang W. A tourniquet assisted cardiopulmonary resuscitation augments myocardial perfusion in a porcine model of cardiac arrest. Resuscitation 2014; 86:49-53. [PMID: 25447436 DOI: 10.1016/j.resuscitation.2014.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/27/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE During cardiopulmonary resuscitation (CPR), myocardial blood flow generated by chest compression rarely exceeds 35% of its normal level. Cardiac output generated by chest compression decreases gradually with the prolongation of cardiac arrest and resuscitation. Early studies have demonstrated that myocardial blood flow during CPR is largely dependent on peripheral vascular resistance. In this study, we investigated the effects of chest compression in combination with physical control of peripheral vascular resistance assisted by tourniquets on myocardial blood flow during CPR. METHODS Ventricular fibrillation was induced and untreated for 7 min in ten male domestic pigs weighing between 33 and 37 kg. The animals were then randomized to receive CPR alone or a tourniquet assisted CPR (T-CPR). In the CPR alone group, chest compression was performed by a miniaturized mechanical chest compressor. In the T-CPR group, coincident with the start of resuscitation, the thin elastic tourniquets were wrapped around the four limbs from the distal end to the proximal part. After 2 min of CPR, epinephrine (20 μg/kg) was administered via the femoral vein. After 5 min of CPR, defibrillation was attempted by a single 150 J shock. If resuscitation was not successful, CPR was resumed for 2 min before the next defibrillation. The protocol was continued until successful resuscitation or for a total of 15 min. Five minutes after resuscitation, the elastic tourniquets were removed. The resuscitated animals were observed for 2h. RESULTS T-CPR generated significantly greater coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow. There was no difference in both intrathoracic positive and negative pressures between the two groups. All animals were successfully resuscitated with a single shock in both groups. There were no significant changes in hemodynamics observed in the animals treated in the T-CPR group before-and-after the release of tourniquets at post-resuscitation 5 min. CONCLUSIONS T-CPR improves myocardial and cerebral perfusion during CPR. It may provide a new and convenient method for augmenting myocardial and cerebral blood flow during CPR.
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Affiliation(s)
- Zhengfei Yang
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States; Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - David Tang
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States; Eisenhower Medical Center, Rancho Mirage, CA, United States.
| | - Xiaobo Wu
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States.
| | - Xianwen Hu
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States.
| | - Jiefeng Xu
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States.
| | - Jie Qian
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States.
| | - Min Yang
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States.
| | - Wanchun Tang
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States; Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; UC San Diego School of Medicine, San Diego, CA, United States; Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Winkler BE, Hartig F, DuCanto J, Koch A, Georgieff M, Lungwitz YP, Muth CM. Helicopter-based in-water resuscitation with chest compressions: a pilot study. Emerg Med J 2014; 32:553-8. [PMID: 25261005 DOI: 10.1136/emermed-2014-203699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/10/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Drowning is a relevant worldwide cause of severe disability and death. The delay of ventilations and chest compressions is a crucial problem in drowning victims. Hence, a novel helicopter-based ALS rescue concept with in-water ventilation and chest compressions was evaluated. METHODS Cardio pulmonary resuscitation (CPR) and vascular access were performed in a self-inflating Heliboat platform in an indoor wave pool using the Fastrach intubating laryngeal mask, the Oxylator resuscitator, Lund University Cardiopulmonary Assist System (LUCAS) chest compression device and EZ-IO intraosseous power drill. The time requirement and physical exertion on a Visual Analogue Scale (VAS) were compared between a procedure without waves and with moderate swell. RESULTS Measurement of the elapsed time of the various stages of the procedure did not reveal significant differences between calm water and swell: Ventilation was initiated after 02:48 versus 03:02 and chest compression after 04:20 versus 04:18 min; the intraosseous cannulisation was completed after 05:59 versus 06:30 min after a simulated jump off the helicopter. The attachment of the LUCAS to the mannequin and the intraosseous cannulisation was rated significantly more demanding on the VAS during swell conditions. CONCLUSIONS CPR appears to be possible when performed in a rescue platform with special equipment. The novel helicopter-based strategy appears to enable the rescuers to initiate CPR in an appropriate length of time and with an acceptable amount of physical exertion for the divers. The time for the helicopter to reach the patient will have to be very short to minimise neurological damage in the drowning victim.
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Affiliation(s)
- Bernd E Winkler
- Department of Anesthesiology, University Hospital of Wuerzburg, Wuerzburg, Germany Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
| | - Frank Hartig
- Department of Internal Medicine, University of Innsbruck, Innsbruck, Austria
| | - James DuCanto
- Department of Anesthesiology, Medical College of Wisconsin, Aurora St. Luke's Medical Center, Milwaukee, USA
| | - Andreas Koch
- German Naval Medical Institute, Kiel-Kronshagen, Germany
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Xu J, Hu X, Yang Z, Wu X, Bisera J, Sun S, Tang W. Miniaturized mechanical chest compressor improves calculated cerebral perfusion pressure without compromising intracranial pressure during cardiopulmonary resuscitation in a porcine model of cardiac arrest. Resuscitation 2014; 85:683-8. [PMID: 24463224 DOI: 10.1016/j.resuscitation.2014.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 01/06/2014] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE One of the major goals of cardiopulmonary resuscitation (CPR) is to provide adequate oxygen delivery to the brain for minimizing cerebral injury resulted from cardiac arrest. The optimal chest compression during CPR should effectively improve brain perfusion without compromising intracranial pressure (ICP). Our previous study has demonstrated that the miniaturized mechanical chest compressor improved hemodynamic efficacy and the success of CPR. In the present study, we investigated the effects of the miniaturized chest compressor (MCC) on calculated cerebral perfusion pressure (CerPP) and ICP. METHODS Ventricular fibrillation was electrically induced and untreated for 7min in 13 male domestic pigs weighing 39±3kg. The animals were randomized to receive mechanical chest compression with the MCC (n=7), or the Thumper device (n=6). CPR was performed for 5min before defibrillation attempt by a single 150J shock. At 2.5min of CPR, the epinephrine at a dose of 20μg/kg was administered. Additional epinephrine was administered at an interval of 3min thereafter. If resuscitation was not successful, CPR was resumed for an additional 2min prior to the next defibrillation until successful resuscitation or for a total of 15min. Post-resuscitated animals were observed for 2h. RESULTS Significantly greater intrathoracic positive and negative pressures during compression and decompression phases of CPR were observed with the MCC when compared with the Thumper device. The MCC produced significantly greater coronary perfusion pressure and end-tidal carbon dioxide. There were no statistically significant differences in systolic and mean ICP between the two groups; however, both of the measurements were slightly greater in the MCC treated animals. Interestingly, the diastolic ICP was significantly lower in the MCC group, which was closely related to the significantly lower negative intrathoracic pressure in the animals that received the MCC. Most important, systolic, diastolic and mean calculated CerPP were all significantly greater in the animals receiving the MCC. CONCLUSIONS In the present study, mechanical chest compression with the MCC significantly improved calculated CerPP but did not compromise ICP during CPR. It may provide a safe and effective chest compression during CPR. Protocol number: P1205.
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Affiliation(s)
- Jiefeng Xu
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States; Department of Emergency Medicine, Yuyao People's Hospital, Medical School of Ningbo University, Ningbo, China.
| | - Xianwen Hu
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States.
| | - Zhengfei Yang
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States.
| | - Xiaobo Wu
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States.
| | - Joe Bisera
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States; Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.
| | - Shijie Sun
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States; Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States.
| | - Wanchun Tang
- Weil Institute of Critical Care Medicine, Rancho Mirage, CA, United States; Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Department of Emergency Medicine, School of Medicine of the University of California, San Diego, CA, United States.
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10
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Mechanical devices for chest compression. Crit Care Med 2012; 40:3095-6. [DOI: 10.1097/ccm.0b013e31826324fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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