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Hemodynamic values in arrested animals with chest compressions after ROSC. Group IIIa = compressions to a depth of 5cm continued after ROSC; Group IIIb = compressions to a depth of 3cm continued after ROSC; Group IIIc = chest compressions stopped after ROSC; CC1 = chest compressions to a depth of 5cm; DF = ROSC after defibrillation; CC2 = chest compressions in Group IIIa (5cm) and IIIb (3cm) and the same time in Group IIIc; SC = stop compressions in Group IIIa and IIIb and the same time in Group IIIc; ROSC = return of spontaneous circulation; HR = heart rate; SAP = systolic arterial pressure; DAP = diastolic arterial pressure; MAP = mean arterial pressure; CPP = coronary perfusion pressure. *: statistically significant difference between treatment groups. doi:10.1371/journal.pone.0155212.g004
Source publication
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Objective:
Starting chest compressions immediately after a defibrillation shock might be harmful, if the victim already had a return of spontaneous circulation (ROSC) and yet was still being subjected to external compressions at the same time. The objective of this study was to study the influence of chest compressions on circulation during the pe...
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This work proposes a learning model to predict the outcome of electrical defibrillation from ECG signals in ventricular fibrillation (VF) periods, which is a lethal situation happening when a patient is suffering cardiac arrest. An animal experiment of rats is conducted to obtain the ECG signals and necessary information for this study. This propos...
Citations
... 68 There is evidence in experimental pigs of significant and potentially clinically meaningful impairment of perfusion (arterial pressure, CoPP) when chest compressions are administered to animals with a spontaneous heartbeat. 50 ...
... swine underwent chest compression in dorsal recumbency, delivering chest compression to a depth of 35.2-57.0 mm (rescuer targeting 50 mm or 25% of the A-P diameter of the chest) resulted in no difference in ROSC than delivery of chest compression to a depth of for very serious indirectness and serious imprecision) that addressed the PICO question.[45][46][47][48][49][50] In dogs weighing 6-12 kg positioned in dorsal recumbency and receiving 62 compressions per minute with varied chest compression depths, cardiac output varied with chest displacement. ...
Objective
To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps.
Design
Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co‐Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.
Setting
Transdisciplinary, international collaboration in university, specialty, and emergency practice.
Results
Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high‐quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide‐chested dogs. When intubation is not possible, bag–mask ventilation using a tight‐fitting facemask with oxygen supplementation is recommended rather than mouth‐to‐nose ventilation.
Conclusions
These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation‐specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.
... Correctly determining whether a patient has achieved ROSC is equally important. 1 Experimental studies have shown that chest compressions on ROSC may be detrimental to hemodynamics 37 and unnecessary medication. 15 Therefore, there is a need for a more reliable method than pulse palpation. ...
Background/purpose:
Pulse palpation is an unreliable method for diagnosing cardiac arrest. To address this limitation, continuous hemodynamic monitoring may be a viable solution. Therefore, we developed a novel, hands-free Doppler system, RescueDoppler, to detect the pulse continuously in the carotid artery.
Methods:
In twelve pigs, we evaluated RescueDoppleŕs potential to measure blood flow velocity in three situations where pulse palpation of the carotid artery was insufficient: (1) systolic blood pressure below 60 mmHg, (2) ventricular fibrillation (VF) and (3) pulseless electrical activity (PEA). (1) Low blood pressure was induced using a Fogarty balloon catheter to occlude the inferior vena cava. (2) An implantable cardioverter-defibrillator induced VF. (3) Myocardial infarction after microembolization of the left coronary artery caused True-PEA. Invasive blood pressure was measured in the contralateral carotid artery. Time-averaged blood flow velocity (TAV) in the carotid artery was related to mean arterial pressure (MAP) in a linear mixed model.
Results:
RescueDoppler identified pulsatile blood flow in 41/41 events with systolic blood pressure below 60 mmHg, with lowest blood pressure of 19 mmHg. In addition the absence of spontaneous circulation was identified in 21/21 VF events and true PEA in 2/2 events. The intraclass correlation coefficient within animals for TAV and MAP was 0.94 (95% CI. 0.85-0.98).
Conclusions:
In a porcine model, RescueDoppler reliably identified pulsative blood flow with blood pressures below 60 mmHg. During VF and PEA, circulatory arrest was rapidly and accurately demonstrated. RescueDoppler could potentially replace unreliable pulse palpation during cardiac arrest and cardiopulmonary resuscitation.
... The latest AHA CPR guidelines emphasize minimizing interruptions in compressions, for example by re-starting CCs immediately after a defibrillation shock [3,4]. However, chest compressions might be detrimental to hemodynamics in the early post-ROSC stage [5]. Studies have shown that the mechanical force generated by CCs after ROSC in humans could lead to ventricular re-fibrillation [6,7]. ...
In this prospective study we investigated whether the pulse oximetry plethysmographic waveform (POP) could be used to identify return of spontaneous circulation (ROSC) during cardio-pulmonary resuscitation (CPR). Tweleve pigs (28 ± 2 kg) were randomly assigned to two groups: Group I (non-arrested with compressions) (n = 6); Group II (arrested with CPR and defibrillation) (n = 6). Hemodynamic parameters and POP were collected and analyzed. POP was analyzed using both a time domain method and a frequency domain method. In Group I, when compressions were carried out on subjects with a spontaneous circulation, a hybrid fluctuation or “envelope” phenomenon appeared in the time domain method and a “double” or “fusion” peak appeared in the frequency domain method. In Group II, after the period of ventricular fibrillation was induced, the POP waveform disappeared. With compressions, POP showed a regular compression wave. After defibrillation, ROSC, and continued compressions, a hybrid fluctuation or “envelope” phenomenon appeared in the time domain method and a “double” or “fusion” peak appeared in the frequency domain method, similar to Group I. Analysis of POP using the time and frequency domain methods could be used to identify ROSC during CPR.
... The major strength of the present study is the use of a novel PEA-FM model that perhaps more closely mimics maternal CPR. In non-obstetric settings, porcine models of cardiac arrest and resuscitation are relatively well understood [26]. The swine model has several important advantages over other animal models, and outcomes in the swine model seemingly translate well to clinical circumstances [27]. ...
Objective:
The risk of maternal and fetal mortality is high if cardiopulmonary arrest occurs during pregnancy. To assess the best position for maternal cardiopulmonary resuscitation (CPR), a prospective randomized crossover study was undertaken, involving basic life support mannequin-based simulation (BLS-MS) and a swine model of pulseless electrical activity (an unstable cardiac state) incorporating a fetal mannequin (PEA-FM).
Study design:
The BLS-MS (performed by certified rescuers) served to evaluate the quality of chest compressions in 30° left lateral tilt (LLT) and supine positions. Based on a 5-point scale, each rescuer subjectively graded their experience. The PEA-FM model was used to compare coronary perfusion pressure readings during CPR in supine, supine with left uterine displacement, 30° LLT, and 30° right lateral tilt positions. Compression rate and correctness of hand position, compression depth, and recoil were measures of compression quality (BLS-MS).
Results:
Compared with LLT position, supine position enabled correct hand position (rate: 0.99 vs 0.88; p<0.05) and compression depth (rate: 0.76 vs 0.36; p<0.001) significantly more often. Moreover, BLS-MS rescuers found chest compressions significantly easier to perform with the mannequin in supine (vs LLT) position (difficulty score: 1.75 vs 3.95; p<0.001). In the PEA-FM study arm, supine position with left uterine displacement and right lateral tilt positions had the highest and lowest recorded coronary perfusion pressure readings, respectively.
Conclusion:
Supine position with left uterine displacement is optimal for maternal CPR.
The aim of this study was to examine the use of volumetric capnography monitoring to assess cardiopulmonary resuscitation (CPR) effectiveness by correlating it with cardiac output (CO), and to evaluate the effect of epinephrine boluses on both end-tidal carbon dioxide (EtCO2) and the volume of CO2 elimination (VCO2) in a swine ventricular fibrillation cardiac arrest model. Planned secondary analysis of data collected to investigate the use of noninvasive monitors in a pediatric swine ventricular fibrillation cardiac arrest model was performed. Twenty-eight ventricular fibrillatory arrests with open cardiac massage were conducted. During CPR, EtCO2 and VCO2 had strong correlation with CO, measured as a percentage of baseline pulmonary blood flow, with correlation coefficients of 0.83 (p < 0.001) and 0.53 (p = 0.018), respectively. However, both EtCO2 and VCO2 had weak and nonsignificant correlation with diastolic blood pressure during CPR 0.30 (p = 0.484) (95% confidence interval [CI], –0.51–0.83) and 0.25 (p = 0.566) (95% CI, –0.55–0.81), respectively. EtCO2 and VCO2 increased significantly after the first epinephrine bolus without significant change in CO. The correlations between EtCO2 and VCO2 and CO were weak 0.20 (p = 0.646) (95% CI, −0.59–0.79), and 0.27 (p = 0.543) (95% CI, −0.54–0.82) following epinephrine boluses. Continuous EtCO2 and VCO2 monitoring are potentially useful metrics to ensure effective CPR. However, transient epinephrine administration by boluses might confound the use of EtCO2 and VCO2 to guide chest compression.
