OJEM  Vol.2 No.2 , June 2014
Restoring Coronary Perfusion Pressure before Defibrillation after Chest Compression Interruptions
ABSTRACT

Background: Sufficient coronary perfusion pressure (CPP) to provide myocardial reperfusion is required for defibrillation success after prolonged ventricular fibrillation (VF) cardiac arrest. Chest compression interruptions cause a precipitous drop in CPP. Objective: To quantify the ex- tent to which CPP recovers to pre-pause levels following chest compression interruptions. Me- thods: This was a secondary analysis of data from two similar IACUC approved protocols. A total of 105 Yorkshire swine were included and VF was electrically induced. After 10 minutes of untreated VF in the first study (n = 52) and 12 minutes of untreated VF in the second (n = 53), CPR began and epinephrine was administered approximately 2 minutes prior to a planned 10-second pause to record an artifact-free ECG waveform segment. Following this pause, CPR was resumed for 20- seconds prior to defibrillation. CPP data were extracted from three time points: 2 minutes after epinephrine delivery (CPP1); following the chest compression pause (CPP2); and immediately before defibrillation (CPP3). Our primary outcome was defined as the ratio of CPP recovery (CPP3- CPP2) to the drop in CPP (CPP1-CPP2). Results: Interrupting compressions resulted in a significant drop in CPP (29.8 mmHg [95%CI: 26.2, 33.4] to 6.8 mmHg [95%CI: 5.4, 8.2]). Resuming CPR for restored 83% (95%CI: 78%, 86%) of the CPP lost. Conclusion: This study demonstrates that 83% of the decline in CPP values during a planned 10-second interruption in CPR can be restored with a short period of precordial compressions prior to defibrillation.


Cite this paper
Mader, T. , Coute, R. , Kellogg, A. , Harris, J. , Millay, S. and Jensen, L. (2014) Restoring Coronary Perfusion Pressure before Defibrillation after Chest Compression Interruptions. Open Journal of Emergency Medicine, 2, 29-35. doi: 10.4236/ojem.2014.22005.
References
[1]   Redding, J.S. and Pearson, J.W. (1963) Evaluation of Drugs for Cardiac Resuscitation. Anesthesiology, 24, 203-207.
http://dx.doi.org/10.1097/00000542-196303000-00008

[2]   Babbs, C.F. (1980) New versus Old Theories of Blood Flow during CPR. Critical Care Medicine, 8, 191-195.
http://dx.doi.org/10.1097/00003246-198003000-00026

[3]   Ditchey, R.V., Winkler, J.V. and Rhodes, C.A. (1982) Relative Lack of Coronary Blood Flow during Closed-Chest Resuscitation in Dogs. Circulation, 66, 297-302. http://dx.doi.org/10.1161/01.CIR.66.2.297

[4]   Sanders, A.B., Ewy, G.A., Alferness, C.A., et al. (1982) Failure of One Method of Simultaneous Chest Compression, Ventilation, and Abdominal Binding during CPR. Critical Care Medicine, 10, 509-513.
http://dx.doi.org/10.1097/00003246-198208000-00005

[5]   Michael, J.R., Guerci, A.D., Koehler, R.C., et al. (1984) Mechanisms by Which Epinephrine Augments Cerebral and Myocardial Perfusion during Cardiopulmonary Resuscitation in Dogs. Circulation, 69, 822-835.
http://dx.doi.org/10.1161/01.CIR.69.4.822

[6]   Niemann, J.T., Rosborough, J.P., Niskanen, R.A., et al. (1985) Mechanical “Cough” Cardiopulmonary Resuscitation during Cardiac Arrest in Dogs. American Journal of Cardiology, 55, 199-204.
http://dx.doi.org/10.1016/0002-9149(85)90328-5

[7]   Niemann, J.T., Criley, J.M., Rosborough, J.P., et al. (1985) Predictive Indices of Successful Cardiac Resuscitation after Prolonged Arrest and Experimental Cardiopulmonary Resuscitation. Annals of Emergency Medicine, 14, 521-528.
http://dx.doi.org/10.1016/S0196-0644(85)80774-5

[8]   Sanders, A.B., Kern, K.B., Atlas, M., et al. (1985) Importance of the Duration of Inadequate Coronary Perfusion Pressure on Resuscitation from Cardiac Arrest. Journal of the American College of Cardiology, 6, 113-118.
http://dx.doi.org/10.1016/S0735-1097(85)80261-8

[9]   Kern, K.B., Ewy, G.A., Voorhees, W.D., et al. (1988) Myocardial Perfusion Pressure: A Predictor of 24-Hour Survival during Prolonged Cardiac Arrest in Dogs. Resuscitation, 16, 241-250. http://dx.doi.org/10.1016/0300-9572(88)90111-6

[10]   Paradis, N.A., Martin, G.B., Rivers, E.P., et al. (1990) Coronary Perfusion Pressure and the Return of Spontaneous Circulation in Human Cardiopulmonary Resuscitation. JAMA, 263, 1106-1113.
http://dx.doi.org/10.1001/jama.1990.03440080084029

[11]   Cobb, L.A., Fahrenbruch, C.E., Walsh, T.R., et al. (1999) Influence of Cardiopulmonary Resuscitation Prior to Defi- brillation in Patients with Out-of-Hospital Ventricular Fibrillation. JAMA, 281, 1182-1188.
http://dx.doi.org/10.1001/jama.281.13.1182

[12]   Weisfeldt, M.L. and Becker, L.B. (2002) Resuscitation after Cardiac Arrest: A 3-Phase Time-Sensitive Model. JAMA, 288, 3035-3038. http://dx.doi.org/10.1001/jama.288.23.3035

[13]   Wik, L., Hansen, T.B., Fylling, F., et al. (2003) Delaying Defibrillation to Give Basic Cardiopulmonary Resuscitation to Patients with Out-of-Hospital Ventricular Fibrillation: A Randomized Trial. JAMA, 289, 1389-1395.
http://dx.doi.org/10.1001/jama.289.11.1389

[14]   Berg, R.A., Hilwig, R.W., Ewy, G.A., et al. (2004) Precountershock Cardiopulmonary Resuscitation Improves Initial Response to Defibrillation from Prolonged Ventricular Fibrillation: A Randomized, Controlled Swine Study. Critical Care Medicine, 32, 1352-1357. http://dx.doi.org/10.1097/01.CCM.0000127780.01362.E5

[15]   Reynolds, J.C., Salcido, D.D. and Menegazzi, J.J. (2010) Coronary Perfusion Pressure and Return of Spontaneous Circulation after Prolonged Cardiac Arrest. Prehospital Emergency Care, 14, 78-84.
http://dx.doi.org/10.3109/10903120903349796

[16]   Sato, Y., Weil, M.H., Sun, S., et al. (1997) Adverse Effects of Interrupting Precordial Compression during Cardiopulmonary Resuscitation. Critical Care Medicine, 25, 733-736. http://dx.doi.org/10.1097/00003246-199705000-00005

[17]   Mader, T.J., Paquette, A.T., Salcido, D.D., et al. (2009) The Effect of the Preshock Pause on Coronary Perfusion Pressure Decay and Rescue Shock Outcome in Porcine Ventricular Fibrillation. Prehospital Emergency Care, 13, 487-494.
http://dx.doi.org/10.1080/10903120903144916

[18]   Mader, T.J., Kellogg, A.R., Walterscheid, J.K., et al. (2010) A Randomized Comparison of Cardiocerebral and Cardiopulmonary Resuscitation Using a Swine Model of Prolonged Ventricular Fibrillation. Resuscitation, 81, 596-602.
http://dx.doi.org/10.1016/j.resuscitation.2010.01.013

[19]   Salcido, D.D., Kim, Y.M., Sherman, L.D., et al. (2012) Quantitative Waveform Measures of the Electrocardiogram as Continuous Physiologic Feedback during Resuscitation with Cardiopulmonary Bypass. Resuscitation, 83, 505-510.
http://dx.doi.org/10.1016/j.resuscitation.2011.09.018

[20]   (2005) American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 112, IV19-IV34.

[21]   Bossaert, L. and Van Hoeyweghen, R. (1989) Bystander Cardiopulmonary Resuscitation (CPR) in Out-of-Hospital Cardiac Arrest. The Cerebral Resuscitation Study Group. Resuscitation, 17, S55-S69.

[22]   Abella, B.S., Alvarado, J.P., Myklebust, H., et al. (2005) Quality of Cardiopulmonary Resuscitation during In-Hospital Cardiac Arrest. JAMA, 293, 305-310. http://dx.doi.org/10.1001/jama.293.3.305

[23]   Wik, L., Kramer-Johansen, J., Myklebust, H., et al. (2005) Quality of Cardiopulmonary Resuscitation during Out-of- Hospital Cardiac Arrest. JAMA, 293, 299-304. http://dx.doi.org/10.1001/jama.293.3.299

[24]   Edelson, D.P., Abella, B.S., Kramer-Johansen, J., et al. (2006) Effects of Compression Depth and Pre-Shock Pauses Predict Defibrillation Failure during Cardiac Arrest. Resuscitation, 71, 137-145.
http://dx.doi.org/10.1016/j.resuscitation.2006.04.008

[25]   Reynolds, J.C., Salcido, D.D. and Menegazzi, J.J. (2012) Conceptual Models of Coronary Perfusion Pressure and Their Relationship to Defibrillation Success in a Porcine Model of Prolonged Out-of-Hospital Cardiac Arrest. Resuscitation, 83, 900-906. http://dx.doi.org/10.1016/j.resuscitation.2012.01.007

 
 
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