Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: a non-randomized interventional cross-over study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Keith Lurie¹  Demetris Yannopoulos²  Scott McKnite¹  Jennifer Rees¹  Anja Metzger¹  Laura Puertas¹  Guillaume Debaty¹  Younghoon Kwon³ 

[1] Department of Emergency Medicine, University of Minnesota, CMinneapolis, MN, USA;Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA;Department of Medicine-Cardiovascular Division, University of Virginia, Charlottesville, VA, USA

关键词: Intrathoracic pressure regulation;    Intrapleural pressure;    Impedance threshold device;    Cardiopulmonary resuscitation;    Airway pressure;   

Others  :  1231197
DOI  :  10.1186/s13049-015-0164-5

 received in 2015-05-29, accepted in 2015-10-20,  发布年份 2015

【 摘 要 】

Background

The objective of this investigation was to evaluate changes in intrathoracic pressure (Ppl), airway pressure (Paw) and vital organ perfusion pressures during standard and intrathoracic pressure regulation (IPR)-assisted cardiopulmonary resuscitation (CPR).

Methods

Multiple CPR interventions were assessed, including newer ones based upon IPR, a therapy that enhances negative intrathoracic pressure after each positive pressure breath. Eight anesthetized pigs underwent 4 min of untreated ventricular fibrillation followed by 2 min each of sequential interventions: (1) conventional standard CPR (STD), (2) automated active compression decompression (ACD) CPR, (3) ACD+ an impedance threshold device (ITD) CPR or (4) ACD+ an intrathoracic pressure regulator (ITPR) CPR, the latter two representing IPR-based CPR therapies. Intrapleural (Ppl), airway (Paw), right atrial, intracranial, and aortic pressures, along with carotid blood flow and end tidal CO ₂ , were measured and compared during each CPR intervention.

Results

The lowest mean and decompression phase Ppl were observed with IPR-based therapies [Ppl mean (mean ± SE): STD (0.8 ± 1.1 mmHg); ACD (−1.6 ± 1.6); ACD-ITD (−3.7 ± 1.5, p < 0.05 vs. both STD and ACD); ACD-ITPR (−7.0 ± 1.9, p < 0.05 vs. both STD and ACD)] [Ppl decompression (mean ± SE): STD (−6.3 ± 2.2); ACD (−13.0 ± 3.8); ACD-ITD −16.9 ± 3.6, p < 0.05 vs. both STD and ACD); ACD-ITPR −18.7 ± 3.5, p < 0.05 vs. both STD and ACD)]. Interventions with the lower mean or decompression phase Ppl also demonstrated lower Paw and were associated with higher vital organ perfusion pressures.

Conclusions

IPR-based CPR methods, specifically ACD-ITPR, yielded the most pronounced reduction in both Ppl and Paw and resulted in the most favorable augmentation of hemodynamics during CPR.

【 授权许可】

   
2015 Kwon et al.

【 图 表 】

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