Association of arterial blood pressure and CPR quality in a child using three different compression techniques, a case report

Marko Sainio, Robert M Sutton, Heini Huhtala, Joar Eilevstjønn, Jyrki Tenhunen, Klaus T Olkkola, Vinay M Nadkarni, Sanna Hoppu, Marko Sainio, Robert M Sutton, Heini Huhtala, Joar Eilevstjønn, Jyrki Tenhunen, Klaus T Olkkola, Vinay M Nadkarni, Sanna Hoppu

Abstract

A 2-year-old boy found in cardiac arrest secondary to drowning received standard CPR for 35 minutes and was transported to a tertiary hospital for rewarming from hypothermia. Chest compressions in hospital were started using two-thumb encircling hands technique. Subsequently two-thumbs direct sternal compression technique and after sternal force/depth sensor placement, chest compression with classic one-hand technique were done. By using CPR recording/feedback defibrillator, quantitative CPR quality data and invasive arterial pressures were available for analyses for 5 hours and 35 minutes. 316 compressions with the two-thumb encircling hands technique provided a mean (SD) systolic arterial pressure (SAP) of 24 (4) mmHg, mean arterial pressure (MAP) 18 (3) and diastolic arterial pressure (DAP) of 15 (3) mmHg. ~6000 compressions with the two thumbs direct compression technique created a mean SAP of 45 (7) mmHg, MAP 35 (4) mmHg and DAP of 30 (3) mmHg. ~20,000 compressions with the sternal accelerometer in place produced SAP 50 (10) mmHg, MAP 32 (5) mmHg and DAP 24 (4) mmHg. Restoration of spontaneous circulation (ROSC) was achieved at the point when the child achieved normothermia by using peritoneal dialysis. Unfortunately, the child died ten hours after ROSC without any signs of neurological recovery. This case demonstrates improved hemodynamic parameters with classic one-handed technique with real-time quantitative quality of CPR feedback compared to either the two-thumbs encircling hands or two-thumbs direct sternal compression techniques. We speculate that the improved arterial pressures were related to improved chest compression depth when a real-time CPR recording/feedback device was deployed.

Trial registration: ClinicalTrials.gov: NCT00951704.

Figures

Figure 1
Figure 1
Association of Invasive BP from an arterial catheter with chest compression technique.
Figure 2
Figure 2
Association of Invasive BP from an arterial catheter with chest compression depth.

References

    1. Dorfsman ML, Menegazzi JJ, Wadas RJ, Auble TE. Two-thumb vs. two-finger chest compression in an infant model of prolonged cardiopulmonary resuscitation. Acad Emerg Med. 2000;7:1077–1082. doi: 10.1111/j.1553-2712.2000.tb01255.x.
    1. Whitelaw CC, Slywka B, Goldsmith LJ. Comparison of a two-finger versus two thumb method for chest compressions by healthcare providers in an infant mechanical model. Resuscitation. 2000;43:213–216. doi: 10.1016/S0300-9572(99)00145-8.
    1. Stevenson AG, McGowan J, Evans AL, Graham CA. CPR for children: one hand or two. Resuscitation. 2005;64:205–208. doi: 10.1016/j.resuscitation.2004.07.012.
    1. Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW, Berg RA, Sutton RM, Hazinski MF. Part 13: Pediatric Basic Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:862–875. doi: 10.1161/CIRCULATIONAHA.110.971085.
    1. Kramer-Johansen J, Myklebust H, Wik L, Fellows B, Svensson L, Sørebø H, Steen PA. Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: A prospective interventional study. Resuscitation. 2006;71:283–292. doi: 10.1016/j.resuscitation.2006.05.011.
    1. Abella BS, Edelson DP, Kim S, Retzer E, Myklebust H, Barry AM, O′Hearn N, Hoek TL, Becker LB. CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system. Resuscitation. 2007;73:54–61. doi: 10.1016/j.resuscitation.2006.10.027.
    1. Maher KO, Berg RA, Lindsey CW, Simsic J, Mahle WT. Depth of sternal compression and intra-arterial blood pressure during CPR in infants following cardiac surgery. Resuscitation. 2009;80:662–664. doi: 10.1016/j.resuscitation.2009.03.016.
    1. Sutton RM, Niles D, Nysaether J, Abella BS, Arbogast KB, Nishisaki A, Maltese MR, Donoghue A, Bishnoi R, Helfaer MA, Myklebust H, Nadkarni V. Quantitative Analysis of CPR Quality During In-Hospital Resuscitation of Older Children and Adolescents. Pediatrics. 2009;124:494–499. doi: 10.1542/peds.2008-1930.
    1. Nishisaki A, Maltese MR, Niles DE, Sutton RM, Urbano J, Berg RA, Nadkarni VM. Backboards are important when chest compressions are provided on a soft mattress. Resuscitation. 2012;83:1013–1020. doi: 10.1016/j.resuscitation.2012.01.016.

Source: PubMed

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