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Abstract
ObjectiveStarting chest compressions immediately after a defibrillation shock might be harmful, if the victim already had a return of spontaneous circulation (ROSC) and yet was still being subjected to external compressions at the same time. The objective of this study was to study the influence of chest compressions on circulation during the peri-cardiac arrest period.DesignProspective, randomized controlled study.SettingAnimal experimental center in Peking Union Medical Collage Hospital, Beijing, China.SubjectsHealthy 3-month-old male domestic pigs.Interventions44 pigs (28±2 kg) were randomly assigned to three groups: Group I (non-arrested with compressions) (n = 12); Group II (arrested with compressions only) (n = 12); Group III (ROSC after compressions and defibrillation) (n = 20). In Groups I and II, compressions were performed to a depth of 5cm (Ia and IIa, n = 6) or a depth of 3cm (Ib and IIb, n = 6) respectively, while in Group III, the animals which had just achieved ROSC (n = 18) were compressed to a depth of 5cm (IIIa, n = 6), a depth of 3cm (IIIb, n = 6), or had no compressions (IIIc, n = 6). Hemodynamic parameters were collected and analyzed.Measurements and FindingsHemodynamics were statistically different between Groups Ia and Ib when different depths of compressions were performed (p < 0.05). In Group II, compressions were beneficial and hemodynamics correlated with the depth of compressions (p < 0.05). In Group III, compressions that continued after ROSC produced a reduction in arterial pressure (p < 0.05).ConclusionsChest compressions might be detrimental to hemodynamics in the early post-ROSC stage. The deeper the compressions were, the better the effect on hemodynamics during cardiac arrest, but the worse the effect on hemodynamics after ROSC.
Highlights
Sudden cardiac arrest is still a leading cause of death around the world[1]
Chest compressions might be detrimental to hemodynamics in the early post-return of spontaneous circulation (ROSC) stage
The latest European Resuscitation Council (ERC) /American Heart Association(AHA) cardiopulmonary resuscitation (CPR) guidelines emphasized the importance of high quality Chest compressions (CCs), including an adequate rate (100-120/minute), adequate depth (5-6cm), adequate chest recoil after each compression, and minimizing interruptions in compressions [2, 3]
Summary
Chest compressions (CCs) are the foundation of cardiopulmonary resuscitation (CPR). The latest European Resuscitation Council (ERC) /American Heart Association(AHA) CPR guidelines emphasized the importance of high quality CCs, including an adequate rate (100-120/minute), adequate depth (5-6cm), adequate chest recoil after each compression, and minimizing interruptions in compressions [2, 3]. Multiple studies show that high quality CCs are critical during CPR [4, 5]. The rate of CCs seldom matches the inherent heart rate during spontaneous circulation. Some studies have shown that the mechanical force generated by CCs after ROSC in humans could lead to ventricular re-fibrillation [6, 7]. We wonder if performing CCs after ROSC may be causing more harm than good
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