HEMODYNAMIC EFFECT OF EXTERNAL CHEST COMPRESSIONS AT THE LOWER END OF THE STERNUM IN CARDIAC ARREST PATIENTS

Abstract

Background: Little is known about the hemodynamic effects of chest compression at different positions on the sternum during cardiopulmonary resuscitation (CPR). Objectives: This study aimed to test whether external chest compression at the lower end of the sternum as an alternative position (alternative compression) results in superior hemodynamic effects compared to standard external chest compression (standard compression). Methods: We enrolled 17 patients with non-traumatic cardiac arrest who failed to regain spontaneous circulation within 30 min after CPR initiation. Standard compression was begun when cardiac arrest was confirmed. Alternative compression was performed for 2 min if spontaneous circulation was not attained after 30 min of standard CPR. We compared hemodynamics and end-tidal CO2 pressure during the last 2 min of standard compression and during alternative compression. Results: Peak arterial pressure during compression systole (114 +/- 51 vs. 95 +/- 42 mm Hg, p < 0.001) and end-tidal CO2 pressure (11.0 +/- 6.7 vs. 9.6 +/- 6.9 mm Hg, p < 0.05) were higher with alternative than standard compression, whereas arterial pressure during compression diastole, peak right atrial pressure, and coronary perfusion pressure did not differ between standard and alternative compression. Conclusions: Compared to standard compression, alternative compression results in a higher peak arterial pressure and end-tidal CO2 pressure, but no change in coronary perfusion pressure. (C) 2013 Elsevier Inc.