Cough-cardiopulmonary resuscitation in the cardiac catheterization laboratory: hemodynamics during an episode of prolonged hypotensive ventricular tachycardia.
Cough-CPR, a deep rhythmic forceful cough repeated 30-60 times per minute, can be an effective resuscitative technique during emergencies occurring in the cardiac catheterization laboratory. We provide documented evidence on the potential of cough-CPR to maintain adequate systemic arterial blood pressure and consciousness during malignant ventricular arrhythmias, including the longest cough-CPR episode (75-90 sec), with continuous hemodynamics recorded. Results in three patients disclose that 1) mean arterial pressure during cough-CPR was 47-66% of nonarrhythmic baseline at a cough rate of 38-46% of normal sinus rhythm heart rate; 2) mean arterial pressure during hypotensive ventricular tachycardia was 17-60 mm Hg higher with than without cough-CPR; 3) at comparable diastolic pressures (33 vs. 31 mm Hg), systolic arterial pressure during cough-CPR was 40 mm Hg higher than basic CPR; and 4) consciousness can be maintained with cough-CPR during prolonged malignant ventricular arrhythmias. Thus cough-CPR can be a valuable adjunct in maintaining patient stability while definitive therapy for the malignant ventricular arrhythmia is administered.
Miller
B
B
Division of Cardiology, Rose Medical Center, University of Colorado Health Sciences Center, Denver.
Lesnefsky
E
E
Heyborne
T
T
Schmidt
B
B
Freeman
K
K
Breckinridge
S
S
Kelley
K
K
Mann
D
D
Reiter
M
M
D000368:Aged; D000789:Angina, Unstable / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization; D003371:Cough / Q000503:physiopathology*; D004554:Electric Countershock; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology; D012151:Resuscitation / Q000379:methods*; D013610:Tachycardia / Q000503:physiopathology*