title: Developing a kinematic understanding of chest compressions: the impact of depth and release time on blood flow during cardiopulmonary resuscitation.
abstract: BACKGROUND
  Effective cardiopulmonary resuscitation is a critical component of the pre-hospital treatment of cardiac arrest victims. Mechanical chest compression (MCC) devices enable the delivery of MCC waveforms that could not be delivered effectively by hand. While chest compression generated blood flow has been studied for more than 50 years, the relation between sternum kinematics (depth over time) and the resulting blood flow have not been well described. Using a five parameter MCC model, we studied the effect of MCC depth, MCC release time, and their interaction on MCC generated blood flow in a highly instrumented swine model of cardiac arrest.
  
  
  METHODS
  MCC hemodynamics were studied in 17 domestic swine (~30 kg) using multiple extra-vascular flow probes and standard physiological monitoring. After 10 min of untreated ventricular fibrillation, mechanical MCC were started. MCC varied such that sternal release occurred over 100, 200, or 300 ms. MCC were delivered at a rate of 100 per min and at a depth of 1.25″ (n = 9) or at a depth of 1.9″ (n = 8) for a total of 18 min. Transitions between release times occurred every 2 min and were randomized. Linear Mixed Models were used to estimate the effect of MCC depth, MCC release time, and the interaction between MCC depth and release time on physiological outcomes.
  
  
  RESULTS
  Blood pressures were optimized by a 200 ms release. End tidal carbon dioxide (EtCO2) was optimized by a 100 ms release. Blood flows were significantly lower at a 300 ms release than at either a 100 or 200 ms release (p < 0.05). 1.9″ deep MCC improved EtCO2, right atrial pressure, coronary perfusion pressure, inferior vena cava blood flow, carotid blood flow, and renal vein blood flow relative to 1.25″ MCC.
  
  
  CONCLUSIONS
  Deeper MCC improved several hemodynamic parameters. Chest compressions with a 300 ms release time generated less blood flow than chest compressions with faster release times. MCC release time is an important quantitative metric of MCC quality and, if optimized, could improve MCC generated blood flows and pressures.
authors.affiliation: The Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, 3501 Civic Center Blvd, Suite 6026, Philadelphia, PA, 19104, USA. joshua.lampe@uphs.upenn.edu.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Lampe
authors.affiliation: The Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, 3501 Civic Center Blvd, Suite 6026, Philadelphia, PA, 19104, USA. tai.yin@uphs.upenn.edu.
authors.forename: Yin
authors.initials: Y
authors.lastname: Tai
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. bratinovg@email.chop.edu.
authors.forename: George
authors.initials: G
authors.lastname: Bratinov
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. weilandt@email.chop.edu.
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Weiland
authors.affiliation: ZOLL Medical Corporation, Chelmsford, MA, USA. ckaufman@zoll.com.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Kaufman
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. bergra@email.chop.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: The Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, 3501 Civic Center Blvd, Suite 6026, Philadelphia, PA, 19104, USA. lance.becker@uphs.upenn.edu.
authors.forename: Lance B
authors.initials: LB
authors.lastname: Becker
mesh_terms: D000818:Animals; D062186:Arterial Pressure; D062185:Atrial Pressure; D001696:Biomechanical Phenomena; D001775:Blood Circulation; D002245:Carbon Dioxide / Q000378:metabolism; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D006323:Heart Arrest / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D055595:Mechanical Phenomena; D013249:Sternum; D013552:Swine; D013909:Thorax; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide