Coronary perfusion pressure during external chest compression in pseudo-EMD, comparison of systolic versus diastolic synchronization

Norman A. Paradis, Henry R. Halperin, Menekhem Zviman, David Barash, Weilun Quan, Gary Freeman

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background: The fraction of cardiac arrest patients presenting with pulseless electrical activity is increasing, and it is likely that many of these patients have pseudo-electromechanical dissociation (P-EMD), a state in which there is residual cardiac contraction without a palpable pulse. The efficacy of cardiopulmonary resuscitation (CPR) with external chest compression synchronized with the P-EMD cardiac systole and diastole has not been fully evaluated. Hypothesis: During external chest compression in P-EMD, the coronary perfusion pressure (CPP) will be greater with systolic synchronization compared with diastolic phase synchronization. Methods: A porcine model of P-EMD induced by progressive hypoxia with peak aortic pressures targeted to 50. mmHg was used. CPR chest compressions were performed by either load distributing band or vest devices. Paired 10. s intervals of systolic and diastolic synchronization were performed randomly during P-EMD, and aortic, right atrial and CPP were compared. Results: Stable P-EMD was achieved in 8 animals, with 2.6 ± 0.5 matched synchronization pairs per animal. Systolic synchronization was association with increases in relaxation phase aortic pressure (41.7 ± 8.9. mmHg vs. 36.9 ± 8.2. mmHg), and coronary perfusion pressure (37.6 ± 11.7. mmHg vs. 30.2 ± 9.6. mmHg). Diastolic synchronization was associated with an increased right atrial pressure (6.7 ± 4.1. mmHg vs. 4.1 ± 5.7. mmHg). Conclusion: During P-EMD, synchronization of external chest compression with residual cardiac systole was associated with higher CPP compared to synchronization with diastole.

Original languageEnglish (US)
Pages (from-to)1287-1291
Number of pages5
JournalResuscitation
Volume83
Issue number10
DOIs
StatePublished - Oct 2012

Keywords

  • CPR
  • Cardiac arrest
  • Coronary perfusion pressure
  • Electromechanical dissociation
  • Porcine
  • Synchronization

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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