Adverse Hemodynamic Effects of Interrupting Chest Compressions for Rescue Breathing During Cardiopulmonary Resuscitation for Ventricular Fibrillation Cardiac Arrest

TLDR

CC+RB improves oxygenation but does not increase survival in ventricular fibrillation compared to chest compressions alone, as shown in animal and clinical studies. In a randomized swine study, 14 animals received either CC+RB or CC for 12 minutes after 3 minutes of untreated VF, then advanced cardiac life support. CC+RB reduced coronary perfusion pressure, chest compression frequency, and left ventricular blood flow relative to CC alone, yet did not improve oxygen delivery; all animals survived 24 h with 13 exhibiting good neurological outcome, indicating that interrupting compressions for rescue breathing harms hemodynamics during VF CPR.

Abstract

Background Despite improving arterial oxygen saturation and pH, bystander cardiopulmonary resuscitation (CPR) with chest compressions plus rescue breathing (CC+RB) has not improved survival from ventricular fibrillation (VF) compared with chest compressions alone (CC) in numerous animal models and 2 clinical investigations. Methods and Results After 3 minutes of untreated VF, 14 swine (32±1 kg) were randomly assigned to receive CC+RB or CC for 12 minutes, followed by advanced cardiac life support. All 14 animals survived 24 hours, 13 with good neurological outcome. For the CC+RB group, the aortic relaxation pressures routinely decreased during the 2 rescue breaths. Therefore, the mean coronary perfusion pressure of the first 2 compressions in each compression cycle was lower than those of the final 2 compressions (14±1 versus 21±2 mm Hg, P <0.001). During each minute of CPR, the number of chest compressions was also lower in the CC+RB group (62±1 versus 92±1 compressions, P <0.001). Consequently, the integrated coronary perfusion pressure was lower with CC+RB during each minute of CPR ( P <0.05 for the first 8 minutes). Moreover, at 2 to 5 minutes of CPR, the median left ventricular blood flow by fluorescent microsphere technique was 60 mL · 100 g −1 · min −1 with CC+RB versus 96 mL · 100 g −1 · min −1 with CC, P <0.05. Because the arterial oxygen saturation was higher with CC+RB, the left ventricular myocardial oxygen delivery did not differ. Conclusions Interrupting chest compressions for rescue breathing can adversely affect hemodynamics during CPR for VF.