Abstract
Introduction
Mechanical chest compression devices allow for variation in chest compression (CCs)
characteristics from moment to moment, enabling therapy that is not feasible for manual
CCs. Effects of varying compressions over time have not been studied. In a randomized
trial in an experimental model of prolonged cardiac arrest, we compared time-varying
CPR (TVCPR), alternating between 100 and 200 compressions per minute (cpm) every 6 s,
to guidelines CPR (Control).
Methods
Ventricular fibrillation (VF) was electrically induced in 20 anesthetized pigs (28.4–45.8 kg).
Following 10 min of untreated VF, cardiopulmonary resuscitation (CPR) began, randomized
to TVCPR or Control. Rate of return of spontaneous circulation (ROSC), 4-h survival,
and hemodynamics during the first 5 min of CPR were compared between groups. Moment-to-moment
hemodynamic effects of changing the CC rate were analyzed.
Results
TVCPR improved the proportion of ROSC over time compared to Control (p < 0.05) but ROSC (9/10 vs. 5/10) and 4-h survival (8/10 vs 5/10) did not differ significantly
between groups. During CPR, coronary and cerebral perfusion pressures and femoral
artery pressure did not differ between groups; however, end-tidal CO2 and mixed venous O2 saturation were higher, and pulmonary artery pressure was lower (p < 0.05) for TVCPR than Control. During TVCPR, switching to 100 cpm increased coronary
perfusion pressure (p < 0.05), and switching to 200 cpm increased cerebral perfusion pressure (p < 0.05).
Conclusions
Time-varying CPR significantly improved indicators of net forward blood flow and proportion
of ROSC over time without negatively impacting perfusion pressures. Alternating CC
rate alternates between perfusion pressures favoring the brain and those favoring
the heart. Time-varying CPR represents a new avenue of research for optimizing CPR.
Institutional Protocol Number
University of Alabama at Birmingham Institutional Animal Care and Use Committee (IACUC)
Protocol Number 140406860.
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Article info
Publication history
Published online: April 10, 2021
Accepted:
March 29,
2021
Received in revised form:
March 8,
2021
Received:
December 21,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
