Effect of Continuous Anterior Chest Compression on Ventilation/Perfusion Ratio and Hemodynamics (HemodyCACC)

Evaluation of the Effects of Continuous Anterior Chest Compression on Ventilation/Perfusion Ratios and Hemodynamics in SDRA

Intro:

The mortality of acute respiratory distress syndrome (ARDS) remains high (40%), and may be aggravated by ventilation-induced lung injury (VILI), the main mechanisms of which are:

1. Anterior region overdistension,
2. Atelectrauma in the posterior regions. Positive expiratory pressure (PEEP) adjusted on the ventilator during ARDS aims to recruit posterior pulmonary territories in order to limit atelectrauma but is accompanied by a concomitant risk of overdistension of anterior territories.

Recent data suggest that continuous anterior chest compression (CACC) could limit the overdistension of the anterior regions by decreasing the compliance of the anterior chest wall and thus the regional transpulmonary pressure, while promoting the redistribution of ventilation to the posterior territories.

The effects of CCAC on ventilation/perfusion ratios and hemodynamics are unknown.

Hypothesis/Objective :

The participants hypothesize that during ARDS, CCAC:

1. Improves ventilation/perfusion ratios by decreasing both anterior territory dead space effect and posterior territory shunt,
2. Induce an improvement in cardiac output by decreasing right ventricular afterload (decrease in capillary compression related to the overdistension of the anterior territories and decrease in hypoxic vasoconstriction of the condensed territories).

Objective:

Primary outcome :

To evaluate the effects of CCAC on ventilation/perfusion ratios during moderate to severe ARDS.

Secondary outcome :

To evaluate the effects of CCAC on hemodynamics : left heart morphology, systolic and diastolic function, cardiac output, right heart morphology, systolic function, pulmonary hypertension, volemia.

Method In patient with moderate to severe ARDS, CACC is performed manually and the pressure applied will be maintained between 60 and 80 cmH2O.

Electrical impedance tomography of ventilation and perfusion will be used for the measurement of the percentage of areas with normal VA/Q ratios, areas of shunt and areas of dead space effect.

Left heart morphology, systolic and diastolic function, cardiac output, right heart morphology, systolic function, pulmonary hypertension, volemia will be evaluated by using echocardiography.

Study Overview

• Status: Completed
• Conditions: Acute Respiratory Distress Syndrome
• Intervention / Treatment: Other: Continuous anterior chest compression

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• France
  • Creteil
    • Créteil, Creteil, France, 94010
      • Henri Mondor Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥ 18 years
• ARDS moderate to severe according to the Berlin criteria
• Patient receiving continuous sedation and curarization
• Free and informed consent from the patient or family member

Exclusion Criteria:

• Pregnancy
• Adult patient subject to a legal protection measure (tutor, curator, etc.)
• Patients with a pacemaker, automatic implantable cardioverter defibrillator,
• Contraindications to thoracic belt placement (e.g., thoracic or spinal cord trauma, recent thoracic surgery)
• Undrained pneumothorax, bronchopleural fistula
• Hemodynamic instability (i.e., use of intravenous fluids of more than 10 mL/kg or vasopressors 2 mg/h of norepinephrine or 0.5 mg/h of epinephrine)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Patient with moderate to severe ARDS under sedation andcontinuous curarization	Other: Continuous anterior chest compression; CACC is performed manually and the pressure applied will be maintained between 60 and 80 cmH2O.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
percentage of areas with normal VA/Q ratios, areas of shunt and areas of dead space effect.	demonstration that CACC may improve VA/Q ratio by using electrical impedance tomography	28 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
CACC may induce a modification in cardiac output by decreasing right ventricular afterload	measurement of cardiac output with echocardiography via : left ventricle outflow tract velocity time integral cm)	28 days
CACC may induce a modification in patient with right ventricular injury	RV/LV : right ventricle end-diastolic ratio, to LV end-diastolic diameter ratio, sLV eccentricity index : systolic left ventricle eccentricity index; ACP : Acute cor pulmonale	28 days
CACC may induce a modification in right systolic function	measurement of right systolic function paramaters : TAPSE (mm) , S' annular tricuspid wave (m/s), RVFAC (%)	28 days
CACC may induce a modification in left systolic function	LVEF : left ventricular ejection fraction	28 days
CACC may induce a modification in ventilation distribution	ventilation distribution antero-posterior and right/left, assessed by electrical impedance tomography	28 days
CACC may induce a modification in lung perfusion distribution	lung perfusion distribution antero-posterior and right/left assessed by electrical impedance tomography	28 days

Collaborators and Investigators

• Sponsor: Assistance Publique - Hôpitaux de Paris

Study record dates

Study Major Dates

• Study Start (Actual): February 28, 2023
• Primary Completion (Actual): June 30, 2024
• Study Completion (Actual): June 30, 2024

Study Registration Dates

• First Submitted: February 28, 2023
• First Submitted That Met QC Criteria: November 19, 2024
• First Posted (Actual): November 21, 2024

Study Record Updates

• Last Update Posted (Actual): January 15, 2026
• Last Update Submitted That Met QC Criteria: January 14, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: ARDS; cardiac output; ventilation perfusion ratio
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Respiration Disorders; Respiratory Distress Syndrome
• Other Study ID Numbers: APHP230065

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: DATAS ARE OWN BY ASSISTANCE PUBLIQUE - HOPITAUX DE PARIS, PLEASE CONTACT SPONSOR FOR FURTHER INFORMATION

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No