title: Abdominal compressions increase vital organ perfusion during CPR in dogs: relation with efficacy of thoracic compressions.
abstract: OBJECTIVE
  Abdominal compressions can be interposed between the thoracic compressions of standard CPR (SCPR). The resulting interposed abdominal compression CPR (IAC-CPR) may increase blood pressures and patient survival, particularly if applied as a primary technique after in-hospital cardiac arrest. We used a predominant cardiac compression canine model to study the effects of IAC-CPR on blood pressures and total and vital organ perfusion as a function of time after cardiac arrest and efficacy of SCPR.
  
  
  METHODS
  In a crossover design, we measured blood pressures and total and regional blood flow (radioactive microspheres) during 6-minute episodes of mechanical SCPR and IAC-CPR, both early (4 to 16 minutes) and late (18 to 30 minutes) after induction of ventricular fibrillation in eight dogs (weight, 25 to 33 kg) under neuroleptanalgesia/anesthesia.
  
  
  RESULTS
  During IAC-CPR, the ascending aortic-right atrial pressure gradient increased (P < .05), and retrograde pressure pulses contributed to the rise of ascending aortic pressure. Within 2 minutes after the start of IAC-CPR, end-tidal CO2 fraction increased by 0.6 +/- 0.4 vol% (P < .05), suggesting enhanced venous return. IAC-CPR enhanced (P < .05) total forward blood flow (574 +/- 406 versus 394 +/- 266 mL/minute during SCPR for the early phase) and vital organ perfusion (including myocardium), in both early and late phases. The IAC-CPR-induced augmentation of blood flow was greater if perfusion was relatively high during SCPR.
  
  
  CONCLUSIONS
  Compared with predominant cardiac compressions alone (SCPR), the addition of interposed abdominal compressions (IAC-CPR) improves total and vital organ oxygen delivery through enhanced venous return and perfusion pressures.
authors.affiliation: Medical Intensive Care Unit, Free University Hospital, Amsterdam, The Netherlands.
authors.forename: O S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: A A
authors.initials: AA
authors.lastname: van Lambalgen
authors.forename: A B
authors.initials: AB
authors.lastname: Groeneveld
authors.forename: G C
authors.initials: GC
authors.lastname: van den Bos
authors.forename: L G
authors.initials: LG
authors.lastname: Thijs
mesh_terms: D000005:Abdomen; D000818:Animals; D001794:Blood Pressure; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D018592:Cross-Over Studies; D004285:Dogs; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D012039:Regional Blood Flow; D013909:Thorax