Prevalence and hemodynamic effects of leaning during CPR

Niles, Dana E.; Sutton, Robert M.; Nadkarni, Vinay M.; Glatz, Andrew; Zuercher, Mathias; Maltese, Matthew R.; Eilevstjønn, Joar; Abella, Benjamin S.; Becker, Lance B.; Berg, Robert A.

doi:10.1016/S0300-9572(11)70147-2

« Previous Next »Resuscitation
Volume 82, Supplement 2 , Pages S23-S26, December 2011

Prevalence and hemodynamic effects of leaning during CPR

Dana E. Niles
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Address for correspondence: Dana Niles, MS, Center for Simulation, Advanced Education and Innovation, Room 8NW100, Main Building, The Children's Hospital of Philadelphia, 3th Street and Civic Center Blvd, Philadelphia, PA 19104, USA. Tel.: +1 215-590-4039; fax: +1 215-590-2969
Robert M. Sutton
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
Vinay M. Nadkarni
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
Andrew Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
Mathias Zuercher
- Department of Anesthesiology and Intensive Care, University of Basel, CH 4031, Basel, Switzerland
Matthew R. Maltese
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
Joar Eilevstjønn
- Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway
Benjamin S. Abella
- Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
Lance B. Becker
- Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
Robert A. Berg
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA

Abstract

Background

Cardiopulmonary resuscitation (CPR) guidelines recommend complete release between chest compressions (CC).

Objective

Evaluate the hemodynamic effects of leaning (incomplete chest wall release) during CPR and the prevalence of leaning during CPR.

Results

In piglet ventricular fibrillation cardiac arrests, 10% and 20% (1.8 kg and 3.6 kg, respectively), leaning during CPR increased right atrial pressures, decreased coronary perfusion pressures, and decreased cardiac index and left ventricular myocardial blood flow by nearly 50%. In contrast, residual leaning of a 260 g accelerometer/force feedback device did not adversely affect cardiac index or myocardial blood flow. Among 108 adult in-hospital CPR events, leaning ≥2.5 kg was demonstrable in 91% of the events and 12% of the evaluated CC. For 12 children with in-hospital CPR, 28% of CC had residual leaning ≥2.5 kg and 89% had residual leaning ≥0.5 kg.

Conclusions

Leaning during CPR increases intrathoracic pressure, decreases coronary perfusion pressure, and decreases cardiac output and myocardial blood flow. Leaning is common during CPR.

Keywords: Cardiac arrest , Cardiopulmonary resuscitation , CPR , Children , Pediatric , Leaning , Hemodynamics , Intrathoracic pressure , Incomplete release , Force transducer , Chest recoil