Article Data

  • Views 179
  • Dowloads 17

Original Research

Open Access

Forward blood flow provoked by changing intravascular pressure using an extracorporeal circulation during cardiopulmonary resuscitation

  • Kook-Hyun Lee1
  • Chul-Woo Jung1
  • Jin-Tae Kim1
  • Byeong-Chul Kang2

1Departments of Anesthesiology, Seoul National University Hospital, Seoul, Republic of Korea

2Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea

DOI: 10.22514/sv.2020.16.0082 Vol.17,Issue 1,January 2021 pp.39-43

Published: 08 January 2021

*Corresponding Author(s): Kook-Hyun Lee E-mail: leekh@snu.ac.kr

Abstract

Since both “cardiac pump” and “thoracic pump” theories have been proved during cardiopulmonary resuscitation (CPR), the mechanism of forward blood flow during closed chest compression still remains open to question. The cardiac pump seems to work by the direct compression of the cardiac ventricles between the sternum and vertebral column. A pressure gradient created between the ventricle and aorta generates systemic blood flow. However, the thoracic pump mechanism presumes chest compression causes a rise in intrathoracic pressure which generates a blood flow from the thoracic cavity to the systemic circulation. Retrograde blood flow from the right heart into the systemic veins is prevented by a concomitant collapse of veins at the thoracic inlet. We hypothesize that the intrinsic decrease of vascular resistance from the aorta to peripheral arteries and the existence of competent venous valves enable blood to flow unidirectionally by the fluctuation of intravascular pressures during closed chest compression. The purpose of this study is to prove an antegrade arterial blood flow without cardiac compression and intrathoracic pressure changes in an animal cardiac arrest model. We demonstrate that arterial pulses can be developed by using an extracorporeal circuit, resulting in forward blood flow from the aorta through the systemic vasculature. It can be suggested that changes in intravascular pressure provoked by either cardiac or thoracic pump generate systemic blood flow during closed chest compression, while systemic vascular patency and valve function may be required for successful CPR.

Keywords

Cardiopulmonary resuscitation; Blood flow; Chest compression; Vascular resistance

Cite and Share

Kook-Hyun Lee,Chul-Woo Jung,Jin-Tae Kim,Byeong-Chul Kang. Forward blood flow provoked by changing intravascular pressure using an extracorporeal circulation during cardiopulmonary resuscitation. Signa Vitae. 2021. 17(1);39-43.

References

[1] Deshmukh HG, Weil MH, Gudipati CV, Trevino RP, Bisera J, Rackow EC. Mechanism of blood flow generated by precordial compression during CPR: I. stuides on closed chest precordial compression. Chest. 1989; 95: 1092-1099.

[2] Niemann JT, Rosborough JP, Hausknecht M, Garner D, Criley JM. Pressure-synchronized cineangiography during experimental cardiopul-monary resuscitation. Circulation. 1981; 64: 985-991.

[3] Criley JM, Blaufuss AH, Kissel Gl. Cough-induced cardiac compression. The Journal of the American Medical Association. 1976; 236: 1246-1250.

[4] Porter TR, Ornate JP, Guard CS, Roy VG, Burns CA, Nixon JV. Transesophageal echocardiography to assess mitral valve function and flow during cardiopulmonary resuscitation. The American Journal of Cardiology. 1992; 70: 1056-1060.

[5] Ma MH, Hwang JJ, Lai LP, Wang SM, Huang GT, Shyu KG, et al. Transesophageal echocardiographic assessment of mitral valve position and pulmonary venous flow during cardiopulmonary resuscitation in humans. Circulation. 1995; 92: 854-861.

[6] Mair P, Kornberger E, Schwarz B, Baubin M, Hoermann C. Forward blood flow during cardiopulmonary resuscitation in patients with severe accidental hypothermia: an echocardiographic study. Acta Anaesthesio-logica Scandinavica. 1998; 42: 1139-1144.

[7] Halperin HR, Weiss JL, Guerci AD, Chandra N, Tsitlik JE, Brower R, et al. Cyclic elevation of intrathoracic pressure can close the mitral valve during cardiac arrest in dogs. Circulation. 1988; 78: 754-760.

[8] Bass CF. New versus old theories of blood flow during CPR. Critical Care Medicine. 1980; 8: 191-196.

[9] Rudikoff MT, Maughan WL, Effron M, Freund P, Weisfeldt ML. Mech-anisms of blood flow during cardiopulmonary resuscitation. Circulation. 1980; 61: 345-352.

[10] Redberg RF, Tucker KJ, Cohen TJ, Dutton JP, Callaham ML, Schiller NB. Cardiopulmonary resuscitation: physiology of blood flow during cardiopulmonary resuscitation: a transesophageal echocardiographic study. Circulation. 1993; 88: 534-542.

[11] Maertens VL, De Smedt LE, Lemoyne S, Huybrechts SA, Wouters K, Kalmar AF, et al. Patients with cardiac arrest are ventilated two times faster than guidelines recommend: an observational prehospital study using tracheal pressure measurement. Resuscitation. 2013; 84: 921-926.

[12] Beattie C, Guerci AD, Hall T, Borkon AM, Baumgartner W, Stuart RS, et al. Mechanisms of blood flow during pneumatic vest cardiopulmonary resuscitation. Journal of Applied Physiology. 1991; 70: 454-465.

[13] Chalkias A , Xanthos T. Timing positive-pressure ventilation during chest compression: the key to improving the thoracic pump? European Heart Journal: Acute Cardiovascular Care. 2015; 4: 24-27.

[14] Dokoumetzidis A, Macheras P. A model for transport and dispersion in the circulatory system based on the vascular fractal tree. Annals of Biomedical Engineering. 2003; 31: 284-293.

[15] Chana CK, Vanhoutte PM. Hypoxia, vascular smooth muscles and endothelium. Acta Pharmaceutica Sinica B. 2013; 3: 1-7.

[16] Peng HL, Ivarsen A, Nilsson H, Aalkjaer C. On the cellular mechanism for the effect of acidosis on vascular tone. Acta Physiologica Scandinav-ica. 1998; 164: 517-525.

[17] Paradis NA, Martin GB, Rivers EP, Goetting MG, Appleton TJ, Feingold M, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. Journal of the American Medical Association. 1990; 263: 1106-1113.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

    Top