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Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: a non-randomized interventional cross-over study.

Kwon Y, Debaty G, Puertas L, Metzger A, Rees J, McKnite S, Yannopoulos D, Lurie K - Scand J Trauma Resusc Emerg Med (2015)

Bottom Line: The objective of this investigation was to evaluate changes in intrathoracic pressure (Ppl), airway pressure (Paw) and vital organ perfusion pressures during standard and intrathoracic pressure regulation (IPR)-assisted cardiopulmonary resuscitation (CPR).Multiple CPR interventions were assessed, including newer ones based upon IPR, a therapy that enhances negative intrathoracic pressure after each positive pressure breath.IPR-based CPR methods, specifically ACD-ITPR, yielded the most pronounced reduction in both Ppl and Paw and resulted in the most favorable augmentation of hemodynamics during CPR.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA. yk2j@virginia.edu.

ABSTRACT

Background: The objective of this investigation was to evaluate changes in intrathoracic pressure (Ppl), airway pressure (Paw) and vital organ perfusion pressures during standard and intrathoracic pressure regulation (IPR)-assisted cardiopulmonary resuscitation (CPR).

Methods: Multiple CPR interventions were assessed, including newer ones based upon IPR, a therapy that enhances negative intrathoracic pressure after each positive pressure breath. Eight anesthetized pigs underwent 4 min of untreated ventricular fibrillation followed by 2 min each of sequential interventions: (1) conventional standard CPR (STD), (2) automated active compression decompression (ACD) CPR, (3) ACD+ an impedance threshold device (ITD) CPR or (4) ACD+ an intrathoracic pressure regulator (ITPR) CPR, the latter two representing IPR-based CPR therapies. Intrapleural (Ppl), airway (Paw), right atrial, intracranial, and aortic pressures, along with carotid blood flow and end tidal CO2, were measured and compared during each CPR intervention.

Results: The lowest mean and decompression phase Ppl were observed with IPR-based therapies [Ppl mean (mean ± SE): STD (0.8 ± 1.1 mmHg); ACD (-1.6 ± 1.6); ACD-ITD (-3.7 ± 1.5, p < 0.05 vs. both STD and ACD); ACD-ITPR (-7.0 ± 1.9, p < 0.05 vs. both STD and ACD)] [Ppl decompression (mean ± SE): STD (-6.3 ± 2.2); ACD (-13.0 ± 3.8); ACD-ITD -16.9 ± 3.6, p < 0.05 vs. both STD and ACD); ACD-ITPR -18.7 ± 3.5, p < 0.05 vs. both STD and ACD)]. Interventions with the lower mean or decompression phase Ppl also demonstrated lower Paw and were associated with higher vital organ perfusion pressures.

Conclusions: IPR-based CPR methods, specifically ACD-ITPR, yielded the most pronounced reduction in both Ppl and Paw and resulted in the most favorable augmentation of hemodynamics during CPR.

No MeSH data available.


Related in: MedlinePlus

Ppl (Intrapleural pressure) and Paw (airway pressure) with each intervention. a. Ppl mean; b. Ppl decompression; c. Paw mean; d. Paw decompression. Error bar represents SEM. * denotes p < 0.05 for STD vs. (ACD, ACD ITD, ACD ITPR). + denotes p < 0.05 for ACD vs. (ACD ITD, ACD ITPR). § denotes p < 0.05 for ACD-ITD vs. ACD-ITPR. P values for linear trend were all < 0.05. STD, standard; ACD, active compression decompression, ITD, impedance threshold device; ITPR, intrathoracic pressure regulator
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Fig3: Ppl (Intrapleural pressure) and Paw (airway pressure) with each intervention. a. Ppl mean; b. Ppl decompression; c. Paw mean; d. Paw decompression. Error bar represents SEM. * denotes p < 0.05 for STD vs. (ACD, ACD ITD, ACD ITPR). + denotes p < 0.05 for ACD vs. (ACD ITD, ACD ITPR). § denotes p < 0.05 for ACD-ITD vs. ACD-ITPR. P values for linear trend were all < 0.05. STD, standard; ACD, active compression decompression, ITD, impedance threshold device; ITPR, intrathoracic pressure regulator

Mentions: Figure 3 shows mean Ppl and Paw during the series of 4 CPR interventions. ACD-ITPR CPR resulted in the most negative mean and decompression Ppl. Compared with STD or ACD CPR, mean Ppls of ACD-ITD and ACD-ITPR CPR were more negative. In addition the decompression Ppl of ACD CPR was more negative than that of STD CPR. In turn, the decompression Ppls of ACD-ITD and ACD-ITPR CPR were more negative than that of ACD CPR (Table 2). Similar findings were observed with the mean and decompression Paw. Mean Paws of STD and ACD-CPR were close to a reference pressure point, 0 mmHg (0.3 ± 0.3 and 0.3 ± 0.3, respectively). Both mean and decompression Paws of the ACD-ITD (−2.0 ± 0.6; −9.4 ± 0.8 mmHg) and the ACD-ITPR CPRs (−8.4 ± 1.0; −11.9 ± 0.8 mmHg) were more negative compared with that of either STD or ACD CPR (Table 2) (see Additional file 1: Table S2 for baseline [before arrest] Ppl and Paw).Fig. 3


Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: a non-randomized interventional cross-over study.

Kwon Y, Debaty G, Puertas L, Metzger A, Rees J, McKnite S, Yannopoulos D, Lurie K - Scand J Trauma Resusc Emerg Med (2015)

Ppl (Intrapleural pressure) and Paw (airway pressure) with each intervention. a. Ppl mean; b. Ppl decompression; c. Paw mean; d. Paw decompression. Error bar represents SEM. * denotes p < 0.05 for STD vs. (ACD, ACD ITD, ACD ITPR). + denotes p < 0.05 for ACD vs. (ACD ITD, ACD ITPR). § denotes p < 0.05 for ACD-ITD vs. ACD-ITPR. P values for linear trend were all < 0.05. STD, standard; ACD, active compression decompression, ITD, impedance threshold device; ITPR, intrathoracic pressure regulator
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4625943&req=5

Fig3: Ppl (Intrapleural pressure) and Paw (airway pressure) with each intervention. a. Ppl mean; b. Ppl decompression; c. Paw mean; d. Paw decompression. Error bar represents SEM. * denotes p < 0.05 for STD vs. (ACD, ACD ITD, ACD ITPR). + denotes p < 0.05 for ACD vs. (ACD ITD, ACD ITPR). § denotes p < 0.05 for ACD-ITD vs. ACD-ITPR. P values for linear trend were all < 0.05. STD, standard; ACD, active compression decompression, ITD, impedance threshold device; ITPR, intrathoracic pressure regulator
Mentions: Figure 3 shows mean Ppl and Paw during the series of 4 CPR interventions. ACD-ITPR CPR resulted in the most negative mean and decompression Ppl. Compared with STD or ACD CPR, mean Ppls of ACD-ITD and ACD-ITPR CPR were more negative. In addition the decompression Ppl of ACD CPR was more negative than that of STD CPR. In turn, the decompression Ppls of ACD-ITD and ACD-ITPR CPR were more negative than that of ACD CPR (Table 2). Similar findings were observed with the mean and decompression Paw. Mean Paws of STD and ACD-CPR were close to a reference pressure point, 0 mmHg (0.3 ± 0.3 and 0.3 ± 0.3, respectively). Both mean and decompression Paws of the ACD-ITD (−2.0 ± 0.6; −9.4 ± 0.8 mmHg) and the ACD-ITPR CPRs (−8.4 ± 1.0; −11.9 ± 0.8 mmHg) were more negative compared with that of either STD or ACD CPR (Table 2) (see Additional file 1: Table S2 for baseline [before arrest] Ppl and Paw).Fig. 3

Bottom Line: The objective of this investigation was to evaluate changes in intrathoracic pressure (Ppl), airway pressure (Paw) and vital organ perfusion pressures during standard and intrathoracic pressure regulation (IPR)-assisted cardiopulmonary resuscitation (CPR).Multiple CPR interventions were assessed, including newer ones based upon IPR, a therapy that enhances negative intrathoracic pressure after each positive pressure breath.IPR-based CPR methods, specifically ACD-ITPR, yielded the most pronounced reduction in both Ppl and Paw and resulted in the most favorable augmentation of hemodynamics during CPR.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA. yk2j@virginia.edu.

ABSTRACT

Background: The objective of this investigation was to evaluate changes in intrathoracic pressure (Ppl), airway pressure (Paw) and vital organ perfusion pressures during standard and intrathoracic pressure regulation (IPR)-assisted cardiopulmonary resuscitation (CPR).

Methods: Multiple CPR interventions were assessed, including newer ones based upon IPR, a therapy that enhances negative intrathoracic pressure after each positive pressure breath. Eight anesthetized pigs underwent 4 min of untreated ventricular fibrillation followed by 2 min each of sequential interventions: (1) conventional standard CPR (STD), (2) automated active compression decompression (ACD) CPR, (3) ACD+ an impedance threshold device (ITD) CPR or (4) ACD+ an intrathoracic pressure regulator (ITPR) CPR, the latter two representing IPR-based CPR therapies. Intrapleural (Ppl), airway (Paw), right atrial, intracranial, and aortic pressures, along with carotid blood flow and end tidal CO2, were measured and compared during each CPR intervention.

Results: The lowest mean and decompression phase Ppl were observed with IPR-based therapies [Ppl mean (mean ± SE): STD (0.8 ± 1.1 mmHg); ACD (-1.6 ± 1.6); ACD-ITD (-3.7 ± 1.5, p < 0.05 vs. both STD and ACD); ACD-ITPR (-7.0 ± 1.9, p < 0.05 vs. both STD and ACD)] [Ppl decompression (mean ± SE): STD (-6.3 ± 2.2); ACD (-13.0 ± 3.8); ACD-ITD -16.9 ± 3.6, p < 0.05 vs. both STD and ACD); ACD-ITPR -18.7 ± 3.5, p < 0.05 vs. both STD and ACD)]. Interventions with the lower mean or decompression phase Ppl also demonstrated lower Paw and were associated with higher vital organ perfusion pressures.

Conclusions: IPR-based CPR methods, specifically ACD-ITPR, yielded the most pronounced reduction in both Ppl and Paw and resulted in the most favorable augmentation of hemodynamics during CPR.

No MeSH data available.


Related in: MedlinePlus