Research to Observe the Hemodynamic Changes and Cardiac Function in Active Abdominal Compression-decompression Cardiopulmonary Resuscitation

Zhang Sisen

doi:10.31487/j.jicoa.2018.01.006

Abstract

Objective: Compare the hemodynamic changes and cardiac function between active abdominal compressiondecompression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation. Methods: A prospective controlled trial was conducted. The patients staying in EICU or ICU were the study subjects which were divided into active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) group and standard cardiopulmonary resuscitation (STD-CPR) group randomly. Central venous pressure (CVP), diastolic blood pressure (DBP) and coronary perfusion pressure (CPP) were recorded continuously. Transesophageal echocardiography (TEE) was used to observe the cardiac valves and assess left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF) during CPR. Results: During CPR, LVEDV of two groups both decreased compared with pre-cardiac arrest, which was not statistically significant(P>0.05). LVEDV in AACD-CPR group was larger than STD-CPR group during CPR. But there was not statistically significant (P>0.05). During CPR, LVESV of two groups both increased compared with pre-cardiac arrest, which was statistically significant(P<0.01). LVESV in AACD-CPR group was larger than STDCPR group?P<0.05). But there was not statistically significant(P>0.05). Both AACD-CPR group and STD-CPR group showed significantly decreased LVEF compared with pre-cardic arrest, of which the difference was statistically significant(P<0.01). LVEF in STD-CPR group was higher than AACD-CPR group and there was a tatistically significant difference between them?P<0.05). When compressing chest , mitral valve and tricuspid valve were open and aortic valve and pulmonary valve were closed during the 8 patients of the STD-CPR group. Conclusion: During chest compression, heart pump took effect in a part of patients. However, during abdominal compression, heart was just a channel that blood flowed. The cardiac function in STD-CPR was superior to AACDCPR. However, both of them can produce effective haemodynamics. So, we suggested that AACD-CPR could be used in the patients with the contraindication of STD-CPR.

Highlights

On the basis of predecessors’ researches, Wang et al came up with active abdominal compressiondecompression cardiopulmonary resuscitation (AACD-CPR) innovatively which solves the problems of standard cardiopulmonary resuscitation (STD-CPR) and can be used in patients with chest deformity, rib fracture, etc [3]
left ventricular ejection fraction (LVEF) of STD-CPR group were larger than AACD-CPR group
Many studies indicated that interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) can improve diastolic blood pressure (DBP), coronary perfusion pressure (CPP) and return of spontaneous circulation (ROSC) rate [6,7,8]

Summary

Introduction

More than 544,000 died of cardiac arrest in China yearly [1]. It is important to conduct a timely and effective CPR. Emergency medical service (EMS) and the awareness of CPR have been improved, the morbidity and mortality of cardiac arrest is still very high [2]. With decades of development since its emergence, CPR has improved survival rates and return of spontaneous circulation (ROSC) to some extent, but it is still below expectation. Tranditional CPR can’t satisfy the current clinical request. AACD-CPR generates effective circulating blood flow and ventilation through several mechanisms including “abdominal pump”, “thoracic pump”, and “lung pump” [3]

Methods

Results

Conclusion