Left Ventricular Compressions Improve Return of Spontaneous Circulation and Hemodynamics in a Swine Model of Traumatic Cardiopulmonary Arrest

Background Prehospital cardiopulmonary resuscitation, including closed chest compressions, has commonly been considered ineffective in traumatic cardiopulmonary arrest (TCPA) because traditional chest compressions do not produce substantial cardiac output. However, recent evidence suggests that chest compressions located over the left ventricle produce greater hemodynamics when compared to traditional compressions. We hypothesized that chest compressions located directly over the left ventricle would improve return of spontaneous circulation (ROSC) and hemodynamics, when compared to traditional chest compressions, in a swine model of traumatic cardiopulmonary arrest (TCPA). Methods Transthoracic echocardiography was used to mark the location of the aortic root (traditional compressions), and the center of the left ventricle (LV) on animals (n=26) which were randomized to receive chest compressions in one of the two locations. After hemorrhage, ventricular fibrillation (VF) was induced. After ten minutes of VF, basic life support (BLS) with mechanical CPR was initiated and performed for ten minutes followed by advanced life support (ALS) for an additional ten minutes. During BLS the area of maximal compression was verified using transesophageal echocardiography. Hemodynamic variables were averaged over the final two minutes of BLS and ALS periods. Results Five of the left ventricle group (38%) achieved ROSC compared to zero of the aortic root group (p=0.04). Additionally, there was an increase in aortic systolic blood pressure (SBP), aortic diastolic blood pressure (DBP) and coronary perfusion pressure (CPP) at the end of both the BLS (95% CI SBP -49 to -21, DBP -14 to -5.6 and CPP -15 to -7.4) and ALS (95% CI SBP -66 to -21, DBP -49 to -6.8 and CPP -51 to -7.5) resuscitation periods among the LV group. Conclusions In our swine model of TCPA, chest compressions performed directly over the left ventricle improved ROSC and hemodynamics when compared to traditional chest compressions. Level of Evidence Therapeutic Animal Model, Level I CONFLICT OF INTEREST STATEMENT: None of the authors have any conflicts of interest to disclose. MEETINGS: The data contained in this manuscript were presented as a poster at the 2014 American Heart Association Scientific Sessions, November 15-19, 2014 in Chicago, Illinois, and as an oral presentation at the 2014 Military Health System Research Symposium, August 18-21, 2014 in Fort Lauderdale, Florida. FUNDING: This study was funded by a grant from the Office of the Air Force Surgeon General. The views expressed in this manuscript are those of the authors and do not reflect official policy or position of the United States Government, Department of Defense, or the United States Air Force. © 2018 Lippincott Williams & Wilkins, Inc.

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