Forward blood flow during cardiopulmonary resuscitation in patients with severe accidental hypothermia. An echocardiographic study.
BACKGROUND
The mechanism responsible for the forward blood flow associated with external chest compression is still controversial. Evidence for both blood flow caused by direct cardiac compression and blood flow generated by a general increase in intrathoracic pressure has been found in experimental as well as clinical studies. No data are available concerning the mechanism causing forward blood flow in hypothermic patients undergoing cardiopulmonary resuscitation. Therefore, echocardiographic findings during external chest compression in seven hypothermic arrest victims are reported.


METHODS
All transesophageal echocardiographic studies performed at the Anaesthesia department between 1994 and 1997 were reviewed and seven hypothermic patients with transesophageal echocardiography performed during cardiopulmonary resuscitation were identified.


RESULTS
An open mitral valve or a circumferential reduction in aortic diameter during the compression phase was found in four of seven patients, indicating that primarily an increase in intrathoracic pressure (thoracic pump mechanism) generated forward blood flow. In three patients, mitral valve closure during external chest compression indicated that direct cardiac compression (cardiac pump mechanism) contributed to forward blood flow. Two patients studied during active compression-decompression cardiopulmonary resuscitation demonstrated enhanced right ventricular filling and aortic valve opening during active decompression of the thorax.


CONCLUSIONS
In contrast to normothermic arrest victims, an open mitral valve during external chest compression is a common finding during hypothermia, indicating that thoracic pump mechanism is important for forward blood flow during cardiopulmonary resuscitation in hypothermic arrest victims. Aortic valve opening in two hypothermic arrest victims suggests forward blood flow also during active decompression of the thorax with the Cardiopump.
Mair
P
P
Department of Anaesthesia and Intensive Care Medicine, University of Innsbruck, School of Medicine, Austria.
Kornberger
E
E
Schwarz
B
B
Baubin
M
M
Hoermann
C
C
D000059:Accidents; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology; D001021:Aortic Valve / Q000503:physiopathology; D001775:Blood Circulation / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology; D016887:Cardiopulmonary Resuscitation; D002648:Child; D017548:Echocardiography, Transesophageal; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006336:Heart Massage; D006801:Humans; D007035:Hypothermia / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D011312:Pressure; D011664:Pulmonary Valve / Q000503:physiopathology; D012189:Retrospective Studies; D013909:Thorax / Q000502:physiology; D014261:Tricuspid Valve / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology