Prevalence and hemodynamic effects of leaning during CPR.
BACKGROUND
Cardiopulmonary resuscitation (CPR) guidelines recommend complete release between chest compressions (CC).


OBJECTIVE
Evaluate the hemodynamic effects of leaning (incomplete chest wall release) during CPR and the prevalence of leaning during CPR.


RESULTS
In piglet ventricular fibrillation cardiac arrests, 10% and 20% (1.8 kg and 3.6 kg, respectively), leaning during CPR increased right atrial pressures, decreased coronary perfusion pressures, and decreased cardiac index and left ventricular myocardial blood flow by nearly 50%. In contrast, residual leaning of a 260 g accelerometer/force feedback device did not adversely affect cardiac index or myocardial blood flow. Among 108 adult in-hospital CPR events, leaning ≥ 2.5 kg was demonstrable in 91% of the events and 12% of the evaluated CC. For 12 children with in-hospital CPR, 28% of CC had residual leaning ≥ 2.5 kg and 89% had residual leaning ≥ 0.5 kg.


CONCLUSIONS
Leaning during CPR increases intrathoracic pressure, decreases coronary perfusion pressure, and decreases cardiac output and myocardial blood flow. Leaning is common during CPR.
Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. niles@email.chop.edu
Dana E
DE
Niles
Robert M
RM
Sutton
Vinay M
VM
Nadkarni
Andrew
A
Glatz
Mathias
M
Zuercher
Matthew R
MR
Maltese
Joar
J
Eilevstjønn
Benjamin S
BS
Abella
Lance B
LB
Becker
Robert A
RA
Berg
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology*; D020127:Recovery of Function; D015203:Reproducibility of Results; D013552:Swine