• Kenton L Anderson, Kristin C Fiala, Maria G Castaneda, Susan M Boudreau, Allyson A Araña, and Vikhyat S Bebarta.
• From the Department of Emergency Medicine (K.L.A.), Stanford University School of Medicine, Palo Alto, California; Department of Emergency Medicine (K.C.F.), Madigan Army Medical Center, Tacoma, Washington; CREST Research Program (M.G.C., S.M.B.), Wilford Hall Ambulatory Surgical Center, Lackland AFB, Texas; US Air Force En Route Care Research Center, United States Army Institute of Surgical Research (A.A.A.), Fort Sam Houston, Texas; and Department of Emergency Medicine (V.S.B.), University of Colorado School of Medicine, Aurora, Colorado.
• J Trauma Acute Care Surg. 2018 Aug 1; 85 (2): 303-310.

BackgroundPrehospital cardiopulmonary resuscitation, including closed chest compressions, has commonly been considered ineffective in traumatic cardiopulmonary arrest (TCPA) because traditional chest compressions do not produce substantial cardiac output. However, recent evidence suggests that chest compressions located over the left ventricle (LV) produce greater hemodynamics when compared to traditional compressions. We hypothesized that chest compressions located directly over the LV would improve return of spontaneous circulation (ROSC) and hemodynamics when compared with traditional chest compressions, in a swine model of TCPA.MethodsTransthoracic echocardiography was used to mark the location of the aortic root (traditional compressions), and the center of the LV on animals (n = 26) which were randomized to receive chest compressions in one of the two locations. After hemorrhage, ventricular fibrillation was induced. After 10 minutes of ventricular fibrillation, basic life support (BLS) with mechanical cardiopulmonary resuscitation was initiated and performed for 10 minutes followed by advanced life support (ALS) for an additional 10 minutes. During BLS, the area of maximal compression was verified using transesophageal echocardiography. Hemodynamic variables were averaged over the final 2 minutes of the BLS and ALS periods.ResultsFive (38%) of the LV group achieved ROSC compared with zero of the aortic root group (p = 0.04). Additionally, there was an increase in aortic systolic blood pressure (SBP), aortic diastolic blood pressure (DBP) and coronary perfusion pressure (CPP) at the end of both the BLS (95% confidence interval, SBP, -49 to -21; DBP, -14 to -5.6; and CPP, -15 to -7.4) and ALS (95% confidence interval: SBP, -66 to -21; DBP, -49 to -6.8; and CPP, -51 to -7.5) resuscitation periods among the LV group.ConclusionIn our swine model of TCPA, chest compressions performed directly over the LV improved ROSC and hemodynamics when compared with traditional chest compressions.

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