Improved hemodynamics with a novel chest compression device during treatment of inhospital cardiac arrest

Introduction

Previous research has shown that increased coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR) correlates with increased coronary blood flow and improved survival from sudden cardiac arrest. The purpose of this clinical study was to determine whether a novel chest compression device (AutoPulse; Revivant Corp, Orange County, CA, USA) improves hemodynamics during CPR when compared with manual chest compressions. The AutoPulse is an automated, electromechanical chest compression device that utilizes a load-distributing band to compress the anterior chest. AutoPulse automatically adjusts to the size and shape of each patient.

Methods

With institutional review board approval, 16 terminally ill subjects (68 ± 6 years) who suffered inhospital sudden cardiac arrest were studied. All subjects were endotracheally intubated. Following a minimum of 10 min of failed advanced life support, fluid-filled catheters were advanced into the thoracic aorta and the right atrium, with placement confirmed by pressure waveforms and chest radiograph. Subjects then received alternating periods of manual and AutoPulse chest compressions for 90 s each. Chest compressions were administered at 100/min for manual, and 60/min for AutoPulse. Subjects received bag-valve ventilation (12/min) between compressions. Epinephrine (1 mg IV bolus) was given at the request of the attending physician at 3–5 min intervals. CPP was measured as the difference between the aortic and right atrial pressures during chest decompression.

Results

Peak aortic pressures were higher with AutoPulse chest compressions when compared with manual chest compressions (150 ± 8 vs 122 ± 11 mmHg, P < 0.05; mean ± SEM), as was CPP (20 ± 3 vs 15 ± 3 mmHg, P < 0.02). The AutoPulse improved peak aortic pressure and CPP despite the use of high-quality manual compressions (47 ± 3 kg).

Conclusion

Hemodynamics with the AutoPulse were improved over those of standard manual CPR in this terminally ill patient population. CPP was raised above the level generally associated with improved survival, and strongly suggests that survival may be improved with the use of AutoPulse in viable patients.