The American journal of emergency medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests.
Recent studies evaluating interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) have demonstrated a significant increase in cardiac output, mean arterial pressure, and cerebral perfusion, as compared with standard CPR. A clinical evaluation of IAC-CPR effectiveness on resuscitation outcome has not been reported. A prospective randomized study comparing IAC-CRP with standard CPR for resuscitation of prehospital cardiopulmonary arrest was undertaken using the Milwaukee County Paramedic System. ⋯ To determine whether abdominal compression increases regurgitation, the frequency of emesis before and after intubation was analyzed. No significant difference was found between the IAC-CPR and standard CPR groups. Thus, IAC-CPR applied by paramedics in the field to patients following intubation does not improve cardiac resuscitation rates.
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Presently, there is no reliable noninvasive method of assessing the adequacy of cardiopulmonary resuscitation (CPR). Studies of animals have shown that during prolonged arrest the coronary perfusion pressure (CPP) is correlated with successful resuscitation. During previous studies it appeared that expired PCO2 correlated with CPP. ⋯ A correlation coefficient of 0.78 was calculated based on 368 data points for eight dogs (P less than 0.01). The results of this study indicate that expired PCO2 is positively correlated with CPP in the canine model of CPR. Inasmuch as CPP correlates with survival in prolonged CPR, the noninvasive measurement of PCO2 may be a useful method of assessing the adequacy of CPR.
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This study was undertaken to determine the effect of interposed abdominal compressions (IAC) during cardiopulmonary resuscitation (CPR) on gastric insufflation when the airway is not secured with an endotracheal tube. A canine model was used in which a common ventilation pressure was applied to separate cuffed esophageal and tracheal tubes. Gas entering the stomach was collected by a pre-placed gastrostomy tube leading to a bell spirometer. ⋯ During standard CPR, measurable gastric gas volume was collected in 28 of 30 trials (mean 215 +/- 93 ml/ventilation). During IAC-CPR, in which abdominal pressure was maintained during ventilation after every 5th chest compression, measurable gastric gas was collected in 15 of 30 trials (mean 40 +/- 11 ml/ventilation). Interposed abdominal compressions as an adjunct to standard CPR may not only be of hemodynamic benefit, but may also reduce the incidence of gastric insufflation and attendant complications.
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Despite the problems inherent in estimating blood flow from pressure, determination of systolic arterial pressure during cardiopulmonary resuscitation (CPR) is common and probably valuable as an indicator of potential systemic flow. The addition of interposed abdominal compression (IAC) to closed-chest CPR has been promoted because of its potential to increase systolic arterial pressure during CPR. ⋯ Two distinct methods of CPR were studied in conjunction with IAC. In six humans, there was no significant increase late in the resuscitative process in systolic arterial pressure or in DA-DCVP difference with IAC as compared with the two methods of CPR studied without IAC.
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This study was undertaken to characterize blood gas, pH, and lactate changes during and after cardiopulmonary resuscitation (CPR) in arterial and venous samples. Blood samples were withdrawn from the brachial artery, aortic arch, pulmonary artery, coronary sinus, and either the right or left cardiac ventricle of 24 anesthetized dogs. Ventricular fibrillation (VF) was induced electrically, and mechanical CPR was begun. ⋯ Lactate increased to 32 mg/dl during 9 minutes of CPR and did not significantly differ after defibrillation. Blood gases and pH returned to control values within an hour. This study suggests that arterial blood gases are sensitive to rapid changes occurring in the pulmonary capillary bed, while venous blood gases reflect changes occurring in the systemic capillary bed.