Suction cup on a piston-based chest compression device improves coronary perfusion pressure and cerebral oxygenation during experimental cardiopulmonary resuscitation

Johan Mälberg; David Smekal; Silvia Marchesi; Miklós Lipcsey; Sten Rubertsson

doi:10.1016/j.resplu.2022.100311

Suction cup on a piston-based chest compression device improves coronary perfusion pressure and cerebral oxygenation during experimental cardiopulmonary resuscitation

Resusc Plus. 2022 Sep 29:12:100311. doi: 10.1016/j.resplu.2022.100311. eCollection 2022 Dec.

Authors

Johan Mälberg^{1

2}, David Smekal^{1

2}, Silvia Marchesi³, Miklós Lipcsey^{2

4}, Sten Rubertsson²

Affiliations

¹ Emergency Medical Service (EMS), Uppsala University Hospital, Sjukhusvägen, 75185 Uppsala, Sweden.
² Anesthesia and Intensive Care Service, Surgical Science Department Sjukhusvägen, 75185, Uppsala University, Uppsala, Sweden.
³ Jolife/Stryker AB, Scheelevägen 23633, Lund, Sweden.
⁴ Hedenstierna Laboratoriet, Uppsala University Hospital, Sjukhusvägen, 75185 Uppsala, Sweden.

Abstract

Introduction: The presented study aimed to investigate whether a mechanical chest compression piston device with a suction cup assisting chest recoil could impact the hemodynamic status when compared to a bare piston during cardiopulmonary resuscitation.

Methods: 16 piglets were anesthetized and randomized into 2 groups. After 3 minutes of induced ventricular fibrillation, a LUCAS 3 device was used to perform chest compressions, in one group a suction cup was mounted on the device's piston, while in the other group, compressions were performed by the bare piston. The device was used in 30:2 mode and the animals were manually ventilated. Endpoints of the study were: end tidal carbon dioxide, coronary and cerebral perfusion pressures, and brain oxygenation (measured using near infrared spectroscopy). At the end of the protocol, the animals that got a return to spontaneous circulation were observed for 60 minutes, then euthanized.

Results: No difference was found in end tidal carbon dioxide or tidal volumes. Coronary perfusion pressure and cerebral oxygenation were higher in the Suction cup group over the entire experiment time, while cerebral perfusion pressure was higher only in the last 5 minutes of CPR. A passive tidal volume (air going in and out the airways during compressions) was detected and found correlated to end tidal carbon dioxide.

Conclusions: The use of a suction cup on a piston-based chest compression device did not increase end tidal carbon dioxide, but it was associated to a higher coronary perfusion pressure.

Keywords: ANOVA, analysis of variance; CPP, coronary perfusion pressure; CPR, cardiopulmonary resuscitation; CVP, central venous pressure; CerPP, cerebral perfusion pressure; Cerebral oxygenation, suction cup; Coronary perfusion pressure; EtCO2, end tidal carbon dioxide; FiO2, inspirated fraction of oxygen; ICP, intracranial pressure; Mechanical chest compression; NIRS, near infrared spectroscopy; PEEP, positive end expiratory pressure; PbtO2, partial pressure of tissue oxygen; Piston-based device; ROSC, return to spontaneous circulation; SD, standard deviation; SrO2, cerebral oxygen saturation; VF, ventricular fibrillation; tV, tidal volume.