Leaning during chest compressions impairs cardiac output and left ventricular myocardial blood flow in piglet cardiac arrest.
OBJECTIVE
Complete recoil of the chest wall between chest compressions during cardiopulmonary resuscitation is recommended, because incomplete chest wall recoil from leaning may decrease venous return and thereby decrease blood flow. We evaluated the hemodynamic effect of 10% or 20% lean during piglet cardiopulmonary resuscitation.


METHODS
Prospective, sequential, controlled experimental animal investigation.


METHODS
University research laboratory.


METHODS
Domestic piglets.


METHODS
After induction of ventricular fibrillation, cardiopulmonary resuscitation was provided to ten piglets (10.7 +/- 1.2 kg) for 18 mins as six 3-min epochs with no lean, 10% lean, or 20% lean to maintain aortic systolic pressure of 80-90 mm Hg. Because the mean force to attain 80-90 mm Hg was 18 kg in preliminary studies, the equivalent of 10% and 20% lean was provided by use of 1.8- and 3.6-kg weights on the chest.


RESULTS
Using a linear mixed-effect regression model to control for changes in cardiopulmonary resuscitation hemodynamics over time, mean right atrial diastolic pressure was 9 +/- 0.6 mm Hg with no lean, 10 +/- 0.3 mm Hg with 10% lean (p < .01), and 13 +/- 0.3 mm Hg with 20% lean (p < .01), resulting in decreased coronary perfusion pressure with leaning. Microsphere-determined cardiac index and left ventricular myocardial blood flow were lower with 10% and 20% leaning throughout the 18 mins of cardiopulmonary resuscitation. Mean cardiac index decreased from 1.9 +/- 0.2 L . M . min with no leaning to 1.6 +/- 0.1 L . M . min with 10% leaning, and 1.4 +/- 0.2 L . M . min with 20% leaning (p < .05). The myocardial blood flow decreased from 39 +/- 7 mL . min . 100 g with no lean to 30 +/- 6 mL . min . 100 g with 10% leaning and 26 +/- 6 mL . min . 100 g with 20% leaning (p < .05).


CONCLUSIONS
Leaning of 10% to 20% (i.e., 1.8-3.6 kg) during cardiopulmonary resuscitation substantially decreased coronary perfusion pressure, cardiac index, and myocardial blood flow.
Zuercher
Mathias
M
University of Arizona Sarver Heart Center, Tucson, AZ, USA.
Hilwig
Ronald W
RW
Ranger-Moore
James
J
Nysaether
Jon
J
Nadkarni
Vinay M
VM
Berg
Marc D
MD
Kern
Karl B
KB
Sutton
Robert
R
Berg
Robert A
RA
D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D011187:Posture; D013552:Swine; D013997:Time Factors