Association of arterial blood pressure and CPR quality in a child using three different compression techniques, a case report

Joar Eilevstjønn,Vinay M Nadkarni,Klaus T Olkkola,Heini Huhtala,Marko Sainio,Sanna Hoppu,Robert M Sutton,Jyrki Tenhunen

doi:10.1186/1757-7241-21-51

Abstract

A 2-year-old boy found in cardiac arrest secondary to drowning received standard CPR for 35 minutes and was transported to a tertiary hospital for rewarming from hypothermia.Chest compressions in hospital were started using two-thumb encircling hands technique. Subsequently two-thumbs direct sternal compression technique and after sternal force/depth sensor placement, chest compression with classic one-hand technique were done. By using CPR recording/feedback defibrillator, quantitative CPR quality data and invasive arterial pressures were available for analyses for 5 hours and 35 minutes.316 compressions with the two-thumb encircling hands technique provided a mean (SD) systolic arterial pressure (SAP) of 24 (4) mmHg, mean arterial pressure (MAP) 18 (3) and diastolic arterial pressure (DAP) of 15 (3) mmHg. ~6000 compressions with the two thumbs direct compression technique created a mean SAP of 45 (7) mmHg, MAP 35 (4) mmHg and DAP of 30 (3) mmHg. ~20,000 compressions with the sternal accelerometer in place produced SAP 50 (10) mmHg, MAP 32 (5) mmHg and DAP 24 (4) mmHg.Restoration of spontaneous circulation (ROSC) was achieved at the point when the child achieved normothermia by using peritoneal dialysis. Unfortunately, the child died ten hours after ROSC without any signs of neurological recovery.This case demonstrates improved hemodynamic parameters with classic one-handed technique with real-time quantitative quality of CPR feedback compared to either the two-thumbs encircling hands or two-thumbs direct sternal compression techniques. We speculate that the improved arterial pressures were related to improved chest compression depth when a real-time CPR recording/feedback device was deployed.Trial registrationClinicalTrials.gov: NCT00951704.

Highlights

A previously healthy 21 month-old child was found floating in a small lake at a home playground approximately 5–10 min after submersion
Restoration of spontaneous circulation (ROSC) was achieved 6 hours and 40 minutes after cardiac arrest and lasted ten hours. For this case report, there was no need for ethics approval according to Finnish practice, but written permission to analyze and report the results was obtained from the parents of the child and from the head of the department, and this study is in compliance with the Helsinki Declaration
The quality deficiencies are similar in adult and pediatric resuscitation attempts, the feedback devices currently available are recommended for children at least 8 years of age

Summary

Introduction

A previously healthy 21 month-old child was found floating in a small lake at a home playground approximately 5–10 min after submersion. Layperson bystander CPR was initiated and the emergency ambulance reached the child within ~15-20 minutes after submersion. The initial documented rhythm on the pre-hospital resuscitation record was asystole. After initial BLS efforts (i.e., bag mask ventilation and provision of chest compressions (CCs), a tracheal tube was placed approximately 15– 20 minutes into the resuscitation. Attempts to obtain intravenous access in the field were unsuccessful. The ambulance staff was instructed to continue resuscitation efforts by the referring emergency physician due to presumed hypothermia, with the plan to rewarm the child by peritoneal dialysis upon arrival to the emergency room (ER). The child arrived to the emergency room approximately 65 minutes after the initiation of out-of-hospital chest compressions

Methods

Results

Conclusion