Hostname: page-component-848d4c4894-p2v8j Total loading time: 0.001 Render date: 2024-05-27T09:28:11.924Z Has data issue: false hasContentIssue false
  • English
  • Français

Standard CPR versus interposed abdominal compression CPR in shunted single ventricle patients: comparison using a lumped parameter mathematical model

Part of: Basic Science

Published online by Cambridge University Press:  24 September 2021

Daniel Stromberg ,
Karen Carvalho ,
Alison Marsden ,
Carlos M. Mery ,
Camille Immanuel ,
Michelle Mizrahi Open the ORCID record for Michelle Mizrahi [Opens in a new window]  and
Weiguang Yang
Daniel Stromberg*
Affiliation:
Departments of Pediatrics and Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children’s Medical Center, Austin, TX, USA
Karen Carvalho
Affiliation:
Departments of Pediatrics and Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children’s Medical Center, Austin, TX, USA
Alison Marsden
Affiliation:
Department of Pediatrics, Stanford University, Stanford, CA, USA Department of Bioengineering, Stanford University, Stanford, CA, USA
Carlos M. Mery
Affiliation:
Departments of Pediatrics and Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children’s Medical Center, Austin, TX, USA
Camille Immanuel
Affiliation:
Departments of Pediatrics and Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children’s Medical Center, Austin, TX, USA
Michelle Mizrahi
Affiliation:
Departments of Pediatrics and Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children’s Medical Center, Austin, TX, USA
Weiguang Yang
Affiliation:
Department of Pediatrics, Stanford University, Stanford, CA, USA Department of Bioengineering, Stanford University, Stanford, CA, USA
*
Author for correspondence: D. Stromberg, MD, Dell Children’s Medical Center, 4900 Mueller Ave., Austin, TX 78723, USA. Tel: (214) 533-5348; Fax: 512-380-7532. E-mail: dstromberg@austin.utexas.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Cardiopulmonary resuscitation (CPR) in the shunted single-ventricle population is associated with poor outcomes. Interposed abdominal compression-cardiopulmonary resuscitation, or IAC-CPR, is an adjunct to standard CPR in which pressure is applied to the abdomen during the recoil phase of chest compressions.

Methods:

A lumped parameter model that represents heart chambers and blood vessels as resistors and capacitors was used to simulate blood flow in both Blalock-Taussig-Thomas and Sano circulations. For standard CPR, a prescribed external pressure waveform was applied to the heart chambers and great vessels to simulate chest compressions. IAC-CPR was modelled by adding phasic compression pressure to the abdominal aorta. Differential equations for the model were solved by a Runge-Kutta method.

Results:

In the Blalock-Taussig-Thomas model, mean pulmonary blood flow during IAC-CPR was 30% higher than during standard CPR; cardiac output increased 21%, diastolic blood pressure 16%, systolic blood pressure 8%, coronary perfusion pressure 17%, and coronary blood flow 17%. In the Sano model, pulmonary blood flow during IAC-CPR increased 150%, whereas cardiac output was improved by 13%, diastolic blood pressure 18%, systolic blood pressure 8%, coronary perfusion pressure 15%, and coronary blood flow 14%.

Conclusions:

In this model, IAC-CPR confers significant advantage over standard CPR with respect to pulmonary blood flow, cardiac output, blood pressure, coronary perfusion pressure, and coronary blood flow. These results support the notion that single-ventricle paediatric patients may benefit from adjunctive resuscitation techniques, and underscores the need for an in-vivo trial of IAC-CPR in children.

Keywords

IAC-CPRsingle-ventricleinterposed abdominal compressions
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 7 , July 2022 , pp. 1122 - 1128
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Voorhees, WD, Babbs, CF, Tacker, WA Jr. Regional blood flow during cardiopulmonary resuscitation in dogs. Crit Care Med 1980; 8: 134–136.10.1097/00003246-198003000-00008CrossRefGoogle ScholarPubMed
Lurie, KG, Nemergut, EC, Yannopoulos, D, et al. The physiology of cardiopulmonary resuscitation. Anes Analg 2016; 122: 767–783.CrossRefGoogle ScholarPubMed
Innes, PA, Summers, CA, Boyd, IM, et al. Audit of pediatric cardiopulmonary resuscitation. Arch Dis Childhood 1993; 68: 487–491.10.1136/adc.68.4.487CrossRefGoogle Scholar
Torres, A Jr, Pickert, CB, Firestone, J, et al. Long-term functional outcome of inpatient pediatric cardiopulmonary resuscitation. Ped Emerg Care 1997; 13: 369–373.10.1097/00006565-199712000-00002CrossRefGoogle ScholarPubMed
Reis, AG, Nadkarni, V, Perondi, MB, et al. A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international utstein reporting style. Pediatrics 2002; 109: 200–209.10.1542/peds.109.2.200CrossRefGoogle ScholarPubMed
Lopez-Herce, J, Garcia, C, Dominguez, P, et al. Characteristics and outcome of cardiorespiratory arrest in children. Resuscitation 2004; 63: 311–320.10.1016/j.resuscitation.2004.06.008CrossRefGoogle ScholarPubMed
Matos, RI, et al. Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Circulation 2013; 127: 442–451.10.1161/CIRCULATIONAHA.112.125625CrossRefGoogle ScholarPubMed
Meaney, PA, Bobrow, BJ, Mancini, ME, et al. Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital. Consensus statement from the American Heart Association. Circulation 2013; 128: 417–435.10.1161/CIR.0b013e31829d8654CrossRefGoogle ScholarPubMed
Morgan, RW, French, B, Kilbaugh, TJ, et al. A quantitative comparison of physiologic indicators of CPR quality: diastolic blood pressure versus end-tidal carbon dioxide. Resuscitation 2016; 104: 6–11.CrossRefGoogle ScholarPubMed
Paradis, NA, Martin, GB, Rivers, EP. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA 1990; 263: 1106–1113.10.1001/jama.1990.03440080084029CrossRefGoogle ScholarPubMed
Berg, RA, Sutton, RM, Reeder, RW, et al. Association between diastolic blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival. Circulation 2018; 137: 1784–1795.10.1161/CIRCULATIONAHA.117.032270CrossRefGoogle ScholarPubMed
Taguchi, I, Ogawa, K, Oida, A, et al. Comparison of hemodynamic effects of enhanced external counterpulsation and intra-aortic ballon pumping in patients with acute myocardial infarction. Am J Card 2000; 86: 1139–1141, a9.10.1016/S0002-9149(00)01175-9CrossRefGoogle Scholar
Sack, JB, Kesselbrenner, MB. Hemodynamics, survival benefits, and complications of interposed abdominal compression during CPR. Acad Emerg Med 1994; 1: 490–497.CrossRefGoogle Scholar
Voorhees, WD, Niebauer, MJ, Babbs, CF. Improved oxygen delivery during cardiopulmonary resuscitation with interposed abdominal compressions. Ann Emerg Med 1983; 12: 128–135.10.1016/S0196-0644(83)80550-2CrossRefGoogle ScholarPubMed
Einagle, V, Bertrand, F, Wise, RA, et al. Interposed abdominal compressions and carotid blood flow during cardiopulmonary resuscitation: support for a thoracoabdominal unit. Chest 1988; 93: 1206–1212.CrossRefGoogle ScholarPubMed
Georgiou, M, Papathanassoglou, E, Middleton, N, et al. Combination of chest compressions and interposed abdominal compressions in a swine model of ventricular fibrillation. Am J Emer Med 2016; 34: 968–974.CrossRefGoogle Scholar
Babbs, CF. Interposed abdominal compression CPR: a comprehensive evidence based review. Resuscitation 2003; 59: 71–82.CrossRefGoogle ScholarPubMed
Babbs, CF. Simplified meta-analysis of clinical trials in resuscitation. Resuscitation 2003; 57: 245–255.10.1016/S0300-9572(03)00038-8CrossRefGoogle ScholarPubMed
Cave, DM, Gazmuri, RJ, Otto, CW, et al. Part 7: CPR techniques and devices, AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010; 122: S720–S728.Google Scholar
Babbs, CF. CPR techniques that combine chest and abdominal compression and decompression, hemodynamic insights from a spreadsheet model. Circulation 1999; 100: 2146–2152.10.1161/01.CIR.100.21.2146CrossRefGoogle ScholarPubMed
Topjian, AA, Raymond, TT, Atkins, D, et al. Part 4: pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2020; 142: S469–S523.CrossRefGoogle ScholarPubMed
Hoekstra, OS, van Lambalgen, AA, Groeneveld, ABJ, et al. Abdominal compressions increase vital organ perfusion during CPR in dogs: relation with efficacy of thoracic compressions. Ann of Emerg Med 1995; 25: 375–385.10.1016/S0196-0644(95)70298-9CrossRefGoogle ScholarPubMed
Movahedi, A, Mirhafez, SR, Behnam-Voshani, H, et al. A comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO 2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med 2016; 23: 448–454.CrossRefGoogle Scholar
Lindner, KH, Ahnefeld, FW, Bowdler, IM. Cardiopulmonary resuscitation with interposed abdominal compression after asphyxial or fibrillatory cardiac arrest in pigs. Anesthesiology 1990; 72: 675–681.CrossRefGoogle ScholarPubMed
Adams, CP, Martin, GB, Rivers, EP, et al. Hemodynamics of interposed abdominal compression during human cardiopulmonary resuscitation. Acad Emerg Med 2008; 1: 498–502.10.1111/j.1553-2712.1994.tb02536.xCrossRefGoogle Scholar
Howard, M, Carrubba, C, Foss, F, et al. Interposed abdominal compression-CPR: its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med 1987; 16: 253–259.CrossRefGoogle ScholarPubMed
Wenzel, V, Lindner, KH, Prengel, AW, et al. Effect of phased chest and abdominal compression-decompression cardiopulmonary resuscitation on myocardial and cerebral blood flow in pigs. Crit Care Med 2000; 28: 1107–1112.CrossRefGoogle ScholarPubMed
Voorhees, WD, Ralston, SH, Babbs, CF. Regional blood flow during cardiopulmonary resuscitation with abdominal counterpulsation in dogs. Am J Emerg Med 1984; 2: 123–128.CrossRefGoogle ScholarPubMed
Gupta, P, Tang, X, Gall, CM, et al. Epidemiology and outcomes of in-hospital cardiac arrest in critically ill children across hospitals of varied center volume: a multi-center analysis. Resuscitation 2014; 85: 1473–1479.10.1016/j.resuscitation.2014.07.016CrossRefGoogle ScholarPubMed
Alten, JA, Klugman, D, Raymond, TT, et al. Epidemiology and outcomes of cardiac arrest in pediatric cardiac intensive care units. Pediatr Crit Care Med 2017; 18: 935–943.10.1097/PCC.0000000000001273CrossRefGoogle Scholar
Roeleveld, PP, Mendonca, M. Neonatal cardiac ECMO in 2019 and beyond. Front Pediatr 2019; 7: 327.CrossRefGoogle ScholarPubMed
Yates, AR, Sutton, RM, Reeder, RW, et al. Survival and cardiopulmonary resuscitation hemodynamics following cardiac arrest in children with surgical compared to medical heart disease. Pediatr Crit Care Med 2019; 20: 1126–1136.CrossRefGoogle ScholarPubMed
Peddy, SB, Fran Hazinski, M, Laussen, PC, et al. Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease. Cardiol Young 2007; 17: 116–126.10.1017/S1047951107001229CrossRefGoogle ScholarPubMed
Jalali, A, et al. Application of mathematical modeling for simulation and analysis of hypoplastic left heart syndrome (HLHS) in pre- and postsurgery conditions. Biomed Res Int 2015; 2015: 987293.10.1155/2015/987293CrossRefGoogle ScholarPubMed