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

Younghoon Kwon, Guillaume Debaty, Laura Puertas, Anja Metzger, Jennifer Rees, Scott McKnite, Demetri Yannopoulos, Keith G Lurie

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

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.

Original languageEnglish (US)
Article number83
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume23
Issue number1
DOIs
StatePublished - Oct 28 2015

Bibliographical note

Publisher Copyright:
© 2015 Kwon et al.

Keywords

  • Airway pressure
  • Cardiopulmonary resuscitation
  • Impedance threshold device
  • Intrapleural pressure
  • Intrathoracic pressure regulation

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