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Standard CPR versus interposed abdominal compression CPR in shunted single ventricle patients: comparison using a lumped parameter mathematical model

Part of: Basic Science

Published online by Cambridge University Press:  24 September 2021

Daniel Stromberg ,
Karen Carvalho ,
Alison Marsden ,
Carlos M. Mery ,
Camille Immanuel ,
Michelle Mizrahi Open the ORCID record for Michelle Mizrahi [Opens in a new window]  and
Weiguang Yang
Daniel Stromberg*
Affiliation:
Departments of Pediatrics and Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children’s Medical Center, Austin, TX, USA
Karen Carvalho
Affiliation:
Departments of Pediatrics and Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children’s Medical Center, Austin, TX, USA
Alison Marsden
Affiliation:
Department of Pediatrics, Stanford University, Stanford, CA, USA Department of Bioengineering, Stanford University, Stanford, CA, USA
Carlos M. Mery
Affiliation:
Departments of Pediatrics and Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children’s Medical Center, Austin, TX, USA
Camille Immanuel
Affiliation:
Departments of Pediatrics and Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children’s Medical Center, Austin, TX, USA
Michelle Mizrahi
Affiliation:
Departments of Pediatrics and Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children’s Medical Center, Austin, TX, USA
Weiguang Yang
Affiliation:
Department of Pediatrics, Stanford University, Stanford, CA, USA Department of Bioengineering, Stanford University, Stanford, CA, USA
*
Author for correspondence: D. Stromberg, MD, Dell Children’s Medical Center, 4900 Mueller Ave., Austin, TX 78723, USA. Tel: (214) 533-5348; Fax: 512-380-7532. E-mail: [email protected]
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Abstract

Introduction:

Cardiopulmonary resuscitation (CPR) in the shunted single-ventricle population is associated with poor outcomes. Interposed abdominal compression-cardiopulmonary resuscitation, or IAC-CPR, is an adjunct to standard CPR in which pressure is applied to the abdomen during the recoil phase of chest compressions.

Methods:

A lumped parameter model that represents heart chambers and blood vessels as resistors and capacitors was used to simulate blood flow in both Blalock-Taussig-Thomas and Sano circulations. For standard CPR, a prescribed external pressure waveform was applied to the heart chambers and great vessels to simulate chest compressions. IAC-CPR was modelled by adding phasic compression pressure to the abdominal aorta. Differential equations for the model were solved by a Runge-Kutta method.

Results:

In the Blalock-Taussig-Thomas model, mean pulmonary blood flow during IAC-CPR was 30% higher than during standard CPR; cardiac output increased 21%, diastolic blood pressure 16%, systolic blood pressure 8%, coronary perfusion pressure 17%, and coronary blood flow 17%. In the Sano model, pulmonary blood flow during IAC-CPR increased 150%, whereas cardiac output was improved by 13%, diastolic blood pressure 18%, systolic blood pressure 8%, coronary perfusion pressure 15%, and coronary blood flow 14%.

Conclusions:

In this model, IAC-CPR confers significant advantage over standard CPR with respect to pulmonary blood flow, cardiac output, blood pressure, coronary perfusion pressure, and coronary blood flow. These results support the notion that single-ventricle paediatric patients may benefit from adjunctive resuscitation techniques, and underscores the need for an in-vivo trial of IAC-CPR in children.

Keywords

IAC-CPRsingle-ventricleinterposed abdominal compressions
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 7 , July 2022 , pp. 1122 - 1128
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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