title: Cardiopulmonary resuscitation with interposed abdominal compression after asphyxial or fibrillatory cardiac arrest in pigs.
abstract: The purpose of this study was to compare the efficacy of standard cardiopulmonary resuscitation and cardiopulmonary resuscitation with interposed abdominal compression for restoration of spontaneous circulation in an asphyxial and fibrillatory arrest model. Twenty-eight pigs weighing 19-27 kg were randomly allocated to two arrest groups. Each of these two groups was then subdivided into a treatment group and a control group resulting in four groups of seven pigs each. In the control groups standard cardiopulmonary resuscitation was performed with a pneumatically driven chest compressor at a rate of 80 beats per min. The animals' lungs were ventilated at a respiratory rate of 20 breaths per min independently of chest compression. In the treatment group, in addition to standard cardiopulmonary resuscitation, manual interposed abdominal compression was applied at the midabdomen in the second half of the relaxation phase using a blood pressure cuff to measure and standardize the compressions. Following asphyxial cardiac arrest of 3 min, none of the seven animals could be resuscitated with standard cardiopulmonary resuscitation, whereas all seven animals could be resuscitated with interposed abdominal compression and standard cardiopulmonary resuscitation after 240 +/- 84 s. Following fibrillatory cardiac arrest of 4 min, none of the seven animals that received standard cardiopulmonary resuscitation and countershocks could be resuscitated. In the group that received standard cardiopulmonary resuscitation and interposed abdominal compression spontaneous circulation was achieved in all animals in 244 +/- 117 s. End-diastolic arteriovenous pressure difference, which correlates with coronary blood flow, was significantly higher with interposed abdominal compression during resuscitation from both forms of cardiac arrest. The results of our study indicate that cardiopulmonary resuscitation with interposed abdominal compression in the second half of the relaxation phase improves diastolic arteriovenous pressure difference and resuscitation success in comparison with that following standard cardiopulmonary resuscitation. The use of interposed abdominal compression during basic cardiac life support should be investigated further in patients.
authors.affiliation: Clinic of Anesthesiology, Ulm University, Federal Republic of Germany.
authors.forename: K H
authors.initials: KH
authors.lastname: Lindner
authors.forename: F W
authors.initials: FW
authors.lastname: Ahnefeld
authors.forename: I M
authors.initials: IM
authors.lastname: Bowdler
mesh_terms: D000005:Abdomen; D000818:Animals; D001237:Asphyxia / Q000150:complications*; D001775:Blood Circulation; D004554:Electric Countershock; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011312:Pressure; D012151:Resuscitation / Q000379:methods*; D013552:Swine; D014693:Ventricular Fibrillation / Q000150:complications* / Q000628:therapy