1025-94 Augmentation of Systolic Pressure and Coronary Perfusion Pressure by Intermittant Airway Occlusion During Active Compression-Decompression CPR in Humans

Abstract

In an effort to improve upon the beneficial hemodynamic effects observed previously with active compression decompression (ACD) cardiopulmonary resuscitation (CPR) in patients in ventricular fibrillation (VF), we tested the hypothesis that intermittant endotracheal tube (ETT) occlusion, performed when not actively ventilating the patient, will increase coronary perfusion by augmenting positive intrathoracic pressures during the compression phase and increasing negative intrathoracic pressures during active decompression. Eight patients undergoing placement of implantable cardioverter-defibrillators received ACD CPR during sustained VF in the operating room when the initial defibrillator shock failed and while the defibrillator was recharging. When the 1st shock failed, the ETT was either transiently occluded or remained patent for 10 seconds while ACD CPR was performed. The operator blinded to the status of ETT patency. Mean ± SEM arterial (art), right atrial (ra), and coronary perfusion (cpp) pressures (mmHg) during compression and decompression were measured. A p value >0.05 was considered not significant (NS). compression decompression art ra cpp art ra cpp Open ETT 38.1 ± 3.5 24.2 ± 2.4 13.9 ± 3.4 25.5 ± 4.2 9.3 ± 3.1 16.2 ± 2.9 Occluded ETT 44.7 ± 43 24.2 ± 2.2 20.5 ± 4.2 306 ± 4.8 10.1 ± 3.2 20.5 ± 3.9 p value = 0.01 NS 0.009 0.03 NS 0.03 We conclude that intermittant impedance to gas exchange during ACD CPR, when not actively ventilating a patient, may augment the beneficial hemodynamic effects of ACD CPR by further enhancing venous return during the active decompression phase and by increasing intrathoracic pressures during chest compression.