title: Comparison of CPR outcome predictors between rhythmic abdominal compression and continuous chest compression CPR techniques.
abstract: OBJECTIVE
  Bystander cardiopulmonary resuscitation (CPR) provides treatment for out-of-hospital cardiac arrest since perfusion of vital organs is critical to resuscitation. Alternatives to standard CPR are evaluated for effectiveness based upon outcome predictive metrics and survival studies. This study focuses on evaluating the performance of rhythmic-only abdominal compression CPR (OAC-CPR) relative to chest compression (CC-CPR) using a complementary suite of mechanistically based CPR outcome predictors. Combined, these predictors provide insight on the transduction of compression-induced pressures into flow perfusing vital organs.
  
  
  METHODS
  Intrasubject comparisons between the CPR techniques were made during multiple 2-min intervals of induced fibrillation in 17 porcine subjects. Arterial pO2, cardiac output, carotid blood flow, coronary perfusion pressure (CPP), minute alveolar ventilation (MAV), end-tidal CO2, and time from defibrillation to the return of spontaneous circulation (ROSC) were recorded. Organ damage was assessed by necropsy.
  
  
  RESULTS
  Compared with CC-CPR, OAC-CPR had higher pressure and ventilation metrics with increased relative CPP (+16 mm Hg), MAV (+75/ml/min/kg) and a lower reduction in arterial pO2(-22% baseline), but suffered from lower carotid flows (-9.3 ml/min). No significant difference was found comparing cardiac outputs. Furthermore, resuscitation was qualitatively more difficult after OAC-CPR, with a longer time to ROSC (+70 s). No abdominal damage was observed over short periods of OAC-CPR.
  
  
  CONCLUSIONS
  Although OAC-CPR appeared superior to CC-CPR by pressure and ventilation metrics, lower carotid flow and longer delay until ROSC raise concerns about overall performance. These paradoxical observations suggest that the evaluation of efficacious alternative CPR techniques may require more direct measurements of vital organ perfusion.
authors.affiliation: Indiana School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Kammeyer
authors.affiliation: Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Pargett
authors.affiliation: Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana, USA.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Rundell
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods*; D002339:Carotid Arteries / Q000502:physiology; D003326:Coronary Circulation / Q000502:physiology; D004195:Disease Models, Animal; D005260:Female; D008297:Male; D017063:Outcome Assessment, Health Care; D012123:Pulmonary Ventilation / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D013552:Swine; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy*
keywords: abdomen; cardiac arrest; resuscitation; resuscitation, effectiveness; resuscitation, research