Blood flow during cardiopulmonary resuscitation with simultaneous compression and ventilation in infant pigs.
We determined whether the simultaneous chest compression and ventilation (SCV) technique of cardiopulmonary resuscitation (CPR) enhances cerebral (CBF) and myocardial (MBF) blood flows and cerebral O2 uptake in an infant swine model of CPR as it does in most adult animal CPR models. We also tested whether SCV-CPR sustains CBF and MBF for prolonged periods of CPR when these flows ordinarily deteriorate. CPR was performed in two groups (n = 8) of pentobarbital anesthetized piglets (3.5-5.5 kg) with continuous epinephrine infusion (10 micrograms/kg/min). Conventional CPR was performed at 100 compressions/min, 60% duty cycle, 1:5 breath to compression ratio and 25-30 mm Hg peak airway pressure. SCV-CPR was performed at 60 compressions/min, 60% duty cycle and 60 mm Hg peak airway pressure applied during each chest compression. Peak right atrial and aortic pressures in excess of 80 mm Hg were generated during CPR in both groups. At 5 min of conventional and SCV-CPR, MBF was 38 +/- 7 and 46 +/- 7 mL.min-1.100 g-1 (+/- SE), respectively, and CBF was 15 +/- 3 and 13 +/- 2 mL.min1. 100 g-1, respectively. However, as CPR was prolonged to 50 min, the sternum progressively lost its recoil and the chest became more deformed. Lung inflation at high airway pressure with SCV-CPR did not prevent this chest deformation. Aortic pressure gradually declined, whereas right atrial and intracranial pressure remained constant in both groups. Consequently, MBF and CBF fell less than 10 mL.min-1.100 g-1 and cerebral O2 uptake was markedly impaired during prolonged conventional and SCV-CPR.(ABSTRACT TRUNCATED AT 250 WORDS)
Berkowitz
I D
ID
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, Maryland 21205.
Chantarojanasiri
T
T
Koehler
R C
RC
Schleien
C L
CL
Dean
J M
JM
Michael
J R
JR
Rogers
M C
MC
Traystman
R J
RJ
D000818:Animals; D001921:Brain / Q000378:metabolism; D002560:Cerebrovascular Circulation; D003326:Coronary Circulation; D005069:Evaluation Studies as Topic; D006439:Hemodynamics; D010101:Oxygen Consumption; D012039:Regional Blood Flow; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods*; D013552:Swine