Abstract 84: Coronary Perfusion Pressure Augmentation by Sustained Abdominal Compression: Comparison with Vasopressor Drugs
Objectives: This study investigated sustained abdominal compression as a means to improve coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR) and compared the resulting CPP augmentation with that achieved using vasopressor drugs.
Method: During electrically induced ventricular fibrillation in anesthetized, 30 kg juvenile pigs, Thumper® CPR was supplemented at intervals either by constant abdominal compression at 100 to 500 mmHg using an inflatable contoured cuff or by the administration of vasopressor drugs (epinephrine, vasopressin, or glibenclamide). CPP before and after cuff inflation or drug administration was the end point.
Results: Sustained abdominal compression at >200 mmHg increases CPP during VF and otherwise standard CPR by 8 to 18 mmHg. The effect persists over practical ranges of chest compression force and duty cycle and is similar to that achieved with vasopressor drugs. Constant abdominal compression also augments CPP after prior administration of epinephrine or vasopressin.
Conclusions: During CPR noninvasive abdominal compression with the inflatable contoured cuff rapidly elevates the CPP, sustains the elevated CPP as long as the device is inflated, and is immediately and controllably reversible upon device deflation. Physical control of peripheral vascular resistance during CPR by abdominal compression has some advantages over pharmacologic manipulation and deserves serious reconsideration, now that the limitations of pressor drugs during CPR have become better understood, including post-resuscitation myocardial depression and the need for intravenous access.