Alternating fast and slow chest compression rates during CPR improved hemodynamics.

Abstract

Mechanical chest compression devices allow for variation in chest compression (CCs) characteristics from moment to moment, enabling therapy that is not feasible for manual CCs. Effects of varying compressions over time have not been studied. In a randomized trial in an experimental model of prolonged cardiac arrest, we compared time-varying CPR (TVCPR), alternating between 100 and 200 compressions per minute (cpm) every 6 s, to guidelines CPR (Control). Ventricular fibrillation (VF) was electrically induced in 20 anesthetized pigs (28.4-45.8 kg). Following 10 min of untreated VF, cardiopulmonary resuscitation (CPR) began, randomized to TVCPR or Control. Rate of return of spontaneous circulation (ROSC), 4-h survival, and hemodynamics during the first 5 min of CPR were compared between groups. Moment-to-moment hemodynamic effects of changing the CC rate were analyzed. TVCPR improved the proportion of ROSC over time compared to Control (p < 0.05) but ROSC (9/10 vs. 5/10) and 4-h survival (8/10 vs 5/10) did not differ significantly between groups. During CPR, coronary and cerebral perfusion pressures and femoral artery pressure did not differ between groups; however, end-tidal CO₂ and mixed venous O₂ saturation were higher, and pulmonary artery pressure was lower (p < 0.05) for TVCPR than Control. During TVCPR, switching to 100 cpm increased coronary perfusion pressure (p < 0.05), and switching to 200 cpm increased cerebral perfusion pressure (p < 0.05). Time-varying CPR significantly improved indicators of net forward blood flow and proportion of ROSC over time without negatively impacting perfusion pressures. Alternating CC rate alternates between perfusion pressures favoring the brain and those favoring the heart. Time-varying CPR represents a new avenue of research for optimizing CPR. University of Alabama at Birmingham Institutional Animal Care and Use Committee (IACUC) Protocol Number 140406860.