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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), Paw (Airway pressure) and vital organ perfusion pressure for each sequential intervention. a. Ppl mean, Paw mean and CPP (coronary perfusion pressure); b. Ppl decompression, Paw decompression and CPP; c. Ppl mean, Paw mean and CePP (cerebral perfusion pressure); d. Ppl decompression, Paw decompression and CePP. Error bar represents SEM. N = 6 for CPP. N = 8 for CePP. * 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 for both CPP and CePP were < 0.05. STD, standard; ACD, active compression decompression, ITD, impedance threshold device; ITPR, intrathoracic pressure regulator
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Fig5: Ppl (Intrapleural pressure), Paw (Airway pressure) and vital organ perfusion pressure for each sequential intervention. a. Ppl mean, Paw mean and CPP (coronary perfusion pressure); b. Ppl decompression, Paw decompression and CPP; c. Ppl mean, Paw mean and CePP (cerebral perfusion pressure); d. Ppl decompression, Paw decompression and CePP. Error bar represents SEM. N = 6 for CPP. N = 8 for CePP. * 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 for both CPP and CePP were < 0.05. STD, standard; ACD, active compression decompression, ITD, impedance threshold device; ITPR, intrathoracic pressure regulator

Mentions: Figure 5 summarizes CPP and CePP during the 4 CPR interventions in relation to Ppl and Paw. The highest CPP was observed during the ACD-ITPR CPR followed by the ACD-ITD CPR. CPP during both ACD-ITPR and ACD-ITD CPR were higher compared to either STD or ACD CPR (Table 1). ACD-ITPR CPR, but not ACD-ITD (17.1 ± 4.1 mmHg), resulted in a higher CePP compared with either STD or ACD CPR (Table 1). Higher CBF was achieved during ACD assisted interventions. Higher ETCO2 was achieved during ACD-ITD or ACD-ITPR interventions versus either STD or ACD CPR (Table 1).Fig. 5


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), Paw (Airway pressure) and vital organ perfusion pressure for each sequential intervention. a. Ppl mean, Paw mean and CPP (coronary perfusion pressure); b. Ppl decompression, Paw decompression and CPP; c. Ppl mean, Paw mean and CePP (cerebral perfusion pressure); d. Ppl decompression, Paw decompression and CePP. Error bar represents SEM. N = 6 for CPP. N = 8 for CePP. * 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 for both CPP and CePP were < 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

Fig5: Ppl (Intrapleural pressure), Paw (Airway pressure) and vital organ perfusion pressure for each sequential intervention. a. Ppl mean, Paw mean and CPP (coronary perfusion pressure); b. Ppl decompression, Paw decompression and CPP; c. Ppl mean, Paw mean and CePP (cerebral perfusion pressure); d. Ppl decompression, Paw decompression and CePP. Error bar represents SEM. N = 6 for CPP. N = 8 for CePP. * 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 for both CPP and CePP were < 0.05. STD, standard; ACD, active compression decompression, ITD, impedance threshold device; ITPR, intrathoracic pressure regulator
Mentions: Figure 5 summarizes CPP and CePP during the 4 CPR interventions in relation to Ppl and Paw. The highest CPP was observed during the ACD-ITPR CPR followed by the ACD-ITD CPR. CPP during both ACD-ITPR and ACD-ITD CPR were higher compared to either STD or ACD CPR (Table 1). ACD-ITPR CPR, but not ACD-ITD (17.1 ± 4.1 mmHg), resulted in a higher CePP compared with either STD or ACD CPR (Table 1). Higher CBF was achieved during ACD assisted interventions. Higher ETCO2 was achieved during ACD-ITD or ACD-ITPR interventions versus either STD or ACD CPR (Table 1).Fig. 5

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