Abstract 169: End Tidal CO2 In Multimodal Vest CPR

Abstract

Introduction: Circumferential constriction vest CPR is more effective at creating forward blood flow than traditional sternal compression only CPR. Active compression-decompression plus the impedance threshold device CPR (ACD-ITD-CPR) incorporates multiple hemodynamic pump mechanisms and also appears more effective. We have developed a new multimodal CPR that combines vest CPR with additional pump mechanisms, one of which is abdominal counterpulsation. Traditional coronary perfusion pressure (CPP) has not been validated during CPR that incorporates compression modalities applied during the relaxation phase. End tidal carbon dioxide (ET-CO2), however, is an indicator of forward blood flow during CPR that is unaffected by relaxation phase compressions. Hypothesis: Multimodal vest CPR that incorporates multiple pump mechanisms may be more effective than standard alternatives as indicated by ET-CO2. Methods: Utilizing a porcine model of ventricular fibrillation, we measured ET-CO2 in: 1) traditional sternal compression CPR (S-CPR), 2) active compression-decompression plus the impedance threshold device CPR (ACD-ITD-CPR) and 3) a new multimodal CPR comprised of circumferential constriction plus abdominal counterpulsation and active sternal decompression (MM-CPR) . After onset of cardiac arrest, 1 min. epochs of each CPR were randomly performed. Results: Seven experiments were performed with a mean number of epochs per experiment of 7. The mean (M + SD) ET-CO2 for S-CPR was 9 + 3 mmHg, for ACD-ITD-CPR 12 + 6, and for MM-CPR 19+8 (P<.05). Conclusions: Multimodal CPR comprising circumferential constriction plus abdominal counterpulsation and active sternal decompression is a promising new type of non-invasive circulatory support.