Abstract 18389: Haemodynamic Outcomes During Piston-Based Mechanical CPR With or Without Active Decompression in a Porcine Model of Cardiac Arrest
Introduction: Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) has been associated with higher cardiac output, coronary perfusion pressure, carotid and brain blood flow compared to standard mechanical chest compressions. Mechanical ACD-CPR devices previously studied are not suitable in the clinical setting of out-of-hospital cardiac arrest, creating a need for a human mechanical ACD-CPR device. We modified LUCAS® 2 (Jolife AB/Physio-Control, Lund, Sweden) to deliver ACD-CPR, hypothesizing that it would improve hemodynamic outcomes compared to standard LUCAS 2 CPR in pigs with cardiac arrest.
Materials and Methods: The modified LUCAS 2 capable of delivering 5cm compressions with or without 2cm active decompression above normal anatomical chest level was studied in a randomized crossover design on nine Norwegian domestic pigs. Ventricular fibrillation was induced and left untreated for 2 min. Each pig received ACD-CPR and regular CPR in three phases of 180 sec in a balanced design, with the first technique repeated last. Aortic-, right atrial-, intracranial- and oesophageal pressures were measured and coronary perfusion pressure calculated. Cerebral and carotid blood flow were continuously measured. Cardiac output was measured once with each CPR technique. Two-sided paired samples t-test was used for continuous parametric data and Wilcoxon test for non-parametric data. P<0.05 was considered significant.
Results: The experimental protocol was finished in eight of the nine pigs. Cardiac output (L/min, median - 25/75 percentiles: 1.5 - 1.1, 1.7 vs. 1.1, 0.8, 1.5, p<0.01), cerebral blood flow (AU, 283 vs. 252, mean difference: 30.8, 95% CI; 2.9 - 58.7, p=0.03), and carotid blood flow (ml/min, 88 vs. 78, mean difference: 10.6, 95% CI: 5.3 - 15.9, p<0.01) were significantly higher during ACD-CPR compared to standard mechanical CPR. There were no significant differences in measured or calculated pressures.
Conclusion: Brain and carotid blood flow improved with ACD-CPR compared to standard CPR with the modified LUCAS 2 device in pigs with cardiac arrest. There was no difference in coronary perfusion pressure. ACD-CPR should be further studied in the clinical setting of out-of-hospital cardiac arrest.
Author Disclosures: M.T. Steinberg: None. J. Olsen: Research Grant; Modest; Zoll Medical. J. Kramer-Johansen: Speakers Bureau; Modest; Laerdal Medical. M. Eriksen: None. A. Neset: None. P.A. Norseng: None. B.M. Hardig: Employment; Significant; PhysioControl. P.A. Steen: Other Research Support; Modest; Laerdal Medical. Consultant/Advisory Board; Significant; Laerdal Medical. L. Wik: Consultant/Advisory Board; Modest; NAKOS rep in PhysioControl. Other; Modest; PI for CIRC sponsored by Zoll, PI for LUCAS2 AD Study Sponsored by PhysioControl.
- © 2016 by American Heart Association, Inc.