Abstract 107: Chest Compression Induced Ventricular Activation, a Novel Phenomenon, During Cardiopulmonary Resuscitation
Objectives: To study chest compressions induced electrical ventricular activation, termed mechano-electrical coupling (MEC), during cardiopulmonary resuscitation (CPR).
Methods: All 102 automated external defibrillators (AED) recordings by non-professional CPR providers from our Utstein style registry of out of hospital resuscitations in Dutch province Limburg between April 2011 and April 2014 were studied regarding chest compressions, organized electrical activity and their mutual relation.
Results: AED population: Mean age was 65 (σ=14.1) years, 75.5% were male, 36.3% had a cardiovascular history. In 73.5% the cause of the arrest was cardiac, in 37.3% by an acute coronary syndrome. Survival to hospital discharge was 34.7%, resp. 44.0% if the cause was cardiac.
AED recordings: Mean duration was 06 minutes and 28 seconds (σ=05:37), first rhythm, was VF in 69%, last monitored rhythm was organized in 50.9%.
During MEC a previously slow intrinsic ventricular rhythm, increased to the frequency of chest compressions. MEC was seen in 15%(n=15) of cases in 30 episodes, during 739 chest compressions, with a mean duration of 14 seconds (σ=8.5) and at a mean compression rate of 122 (σ=19,9)/min. Refibrillation was present in 50% of all patients, spontaneous in 43%, failed shock in 26% or during chest compressions in 31%, however it was not observed during episodes of continuous one-to-one MEC.
No difference was seen in survival to discharge, between patients with and without MEC.
Conclusion: During CPR chest compressions may lead to one to one electrical activation of the ventricles.
MEC may be beneficial: synchronized electrical activity and mechanical compressions may increase stroke volume, and chest compression induced VF may be prevented. Research in larger populations has to be performed as to the incidence of and conditions leading to MEC, such as CPR and patient related variables.
- Cardiopulmonary resuscitation
- Cardiac arrest
- Acute coronary syndromes
- Basic life support
- Ventricular fibrillation
Author Disclosures: N. Hoogkamp: None. R.M. Pijls: None. A.M. Gorgels: None.
- © 2014 by American Heart Association, Inc.