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Haemodynamic outcomes during piston-based mechanical CPR with or without active decompression in a porcine model of cardiac arrest

Steinberg, Mikkel T. ; Olsen, Jan Aage ; Eriksen, Morten ; Neset, Andres ; Norseng, Per Andreas ; Kramer-Johansen, Jo ; Hardig, Bjarne Madsen LU and Wik, Lars (2018) In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 26(31).
Abstract

Background: Experimental active compression-decompression (ACD) CPR is associated with increased haemodynamic outcomes compared to standard mechanical chest compressions. Since no clinically available mechanical chest compression device is capable of ACD-CPR, we modified the LUCAS 2 (Physio-Control, Lund, Sweden) to deliver ACD-CPR, hypothesising it would improve haemodynamic outcomes compared with standard LUCAS CPR on pigs with cardiac arrest. Methods: The modified LUCAS delivering 5 cm compressions with or without 2 cm active decompression above anatomical chest level was studied in a randomized crossover design on 19 Norwegian domestic pigs. VF was electrically induced and untreated for 2 min. Each pig received ACD-CPR and standard... (More)

Background: Experimental active compression-decompression (ACD) CPR is associated with increased haemodynamic outcomes compared to standard mechanical chest compressions. Since no clinically available mechanical chest compression device is capable of ACD-CPR, we modified the LUCAS 2 (Physio-Control, Lund, Sweden) to deliver ACD-CPR, hypothesising it would improve haemodynamic outcomes compared with standard LUCAS CPR on pigs with cardiac arrest. Methods: The modified LUCAS delivering 5 cm compressions with or without 2 cm active decompression above anatomical chest level was studied in a randomized crossover design on 19 Norwegian domestic pigs. VF was electrically induced and untreated for 2 min. Each pig received ACD-CPR and standard mechanical CPR in three 180-s. phases. We measured aortic, right atrial, coronary perfusion, intracranial and oesophageal pressure, cerebral and carotid blood flow and cardiac output. 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: Due to injuries/device failure, the experimental protocol was completed in nine of 19 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, 297 vs. 253, mean difference: 44, 95% CI; 14-74, p=0.01), and carotid blood flow (l/min, median, (25, 75-percentiles): 97 (70, 106) vs. 83 (57, 94), p<0.01) were higher during ACD-CPR compared to standard mechanical CPR. Coronary perfusion pressure (CPP) trended towards higher in end decompression phase. Conclusion: Cardiac output and brain blood flow improved with mechanical ACD-CPR and CPP trended towards higher during end-diastole compared to standard LUCAS CPR.

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author
; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Active decompression, Cardiac arrest, Experimental porcine model
in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
volume
26
issue
31
article number
31
publisher
BioMed Central (BMC)
external identifiers
  • pmid:29690910
  • scopus:85045732703
ISSN
1757-7241
DOI
10.1186/s13049-018-0496-z
project
Helsingborg Resuscitation and Cardiovascular Research Group
language
English
LU publication?
no
id
4733026c-b9db-40c8-9f10-a060c0efa9c2
date added to LUP
2019-05-22 11:49:25
date last changed
2021-03-24 05:18:21
@article{4733026c-b9db-40c8-9f10-a060c0efa9c2,
  abstract     = {<p>Background: Experimental active compression-decompression (ACD) CPR is associated with increased haemodynamic outcomes compared to standard mechanical chest compressions. Since no clinically available mechanical chest compression device is capable of ACD-CPR, we modified the LUCAS 2 (Physio-Control, Lund, Sweden) to deliver ACD-CPR, hypothesising it would improve haemodynamic outcomes compared with standard LUCAS CPR on pigs with cardiac arrest. Methods: The modified LUCAS delivering 5 cm compressions with or without 2 cm active decompression above anatomical chest level was studied in a randomized crossover design on 19 Norwegian domestic pigs. VF was electrically induced and untreated for 2 min. Each pig received ACD-CPR and standard mechanical CPR in three 180-s. phases. We measured aortic, right atrial, coronary perfusion, intracranial and oesophageal pressure, cerebral and carotid blood flow and cardiac output. Two-sided paired samples t-test was used for continuous parametric data and Wilcoxon test for non-parametric data. P&lt;0.05 was considered significant. Results: Due to injuries/device failure, the experimental protocol was completed in nine of 19 pigs. Cardiac output (l/min, median, (25, 75-percentiles): 1.5 (1.1, 1.7) vs. 1.1 (0.8, 1.5), p&lt;0.01), cerebral blood flow (AU, 297 vs. 253, mean difference: 44, 95% CI; 14-74, p=0.01), and carotid blood flow (l/min, median, (25, 75-percentiles): 97 (70, 106) vs. 83 (57, 94), p&lt;0.01) were higher during ACD-CPR compared to standard mechanical CPR. Coronary perfusion pressure (CPP) trended towards higher in end decompression phase. Conclusion: Cardiac output and brain blood flow improved with mechanical ACD-CPR and CPP trended towards higher during end-diastole compared to standard LUCAS CPR.</p>},
  author       = {Steinberg, Mikkel T. and Olsen, Jan Aage and Eriksen, Morten and Neset, Andres and Norseng, Per Andreas and Kramer-Johansen, Jo and Hardig, Bjarne Madsen and Wik, Lars},
  issn         = {1757-7241},
  language     = {eng},
  month        = {04},
  number       = {31},
  publisher    = {BioMed Central (BMC)},
  series       = {Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine},
  title        = {Haemodynamic outcomes during piston-based mechanical CPR with or without active decompression in a porcine model of cardiac arrest},
  url          = {http://dx.doi.org/10.1186/s13049-018-0496-z},
  doi          = {10.1186/s13049-018-0496-z},
  volume       = {26},
  year         = {2018},
}