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García-Vilana S, Kumar V, Kumar S, Barberia E, Landín I, Granado-Font E, Solà-Muñoz S, Jiménez-Fàbrega X, Bardají A, Hardig BM, Azeli Y. Study of risk factors for injuries due to cardiopulmonary resuscitation with special focus on the role of the heart: A machine learning analysis of a prospective registry with multiple sources of information (ReCaPTa Study). Resusc Plus 2024; 17:100559. [PMID: 38586866 PMCID: PMC10995644 DOI: 10.1016/j.resplu.2024.100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 04/09/2024] Open
Abstract
Background The study of thoracic injuries and biomechanics during CPR requires detailed studies that are very scarce. The role of the heart in CPR biomechanics has not been determined. This study aimed to determine the risk factors importance for serious ribcage damage due to CPR. Methods Data were collected from a prospective registry of out-of-hospital cardiac arrest between April 2014 and April 2017. This study included consecutive out-of-hospital CPR attempts undergoing an autopsy study focused on CPR injuries. Cardiac mass ratio was defined as the ratio of real to expected heart mass. Pearson's correlation coefficient was used to select clinically relevant variables and subsequently classification tree models were built. The Gini index was used to determine the importance of the associated serious ribcage damage factors. The LUCAS® chest compressions device forces and the cardiac mass were analyzed by linear regression. Results Two hundred CPR attempts were included (133 manual CPR and 67 mechanical CPR). The mean age of the sample was 60.4 ± 13.5, and 56 (28%) were women. In all, 65.0% of the patients presented serious ribcage damage. From the classification tree build with the clinically relevant variables, age (0.44), cardiac mass ratio (0.26), CPR time (0.22), and mechanical CPR (0.07), in that order, were the most influential factors on serious ribcage damage. The chest compression forces were greater in subjects with higher cardiac mass. Conclusions The heart plays a key role in CPR biomechanics being cardiac mass ratio the second most important risk factor for CPR injuries.
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Affiliation(s)
- Silvia García-Vilana
- Universitat Politècnica de Catalunya (UPC-EPSEVG), Grup de Recerca Aplicada en Biomecànica de l’Impacte (GRABI), Barcelona, Spain
| | - Vikas Kumar
- Environmental Engineering Laboratory, Departament d' Enginyeria Quimica, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
| | - Saurav Kumar
- Environmental Engineering Laboratory, Departament d' Enginyeria Quimica, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
| | - Eneko Barberia
- Institut de Medicina Legal i Ciencies Forenses de Catalunya (IMLCFC), Spain
- Facultat de Ciencies Mèdiques, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Inés Landín
- Institut de Medicina Legal i Ciencies Forenses de Catalunya (IMLCFC), Spain
- Facultat de Ciencies Mèdiques, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Ester Granado-Font
- Centre d'Atenció Primària Horts de Miró (Reus-4), Institut Català de Salut, Reus, Spain
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, Spain
| | - Silvia Solà-Muñoz
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
- Sistema d’Emergències Mèdiques de Catalunya, Spain
| | - Xavier Jiménez-Fàbrega
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
- Facultat de Ciencies Mèdiques, Universitat de Barcelona, Spain
| | - Alfredo Bardají
- Facultat de Ciencies Mèdiques, Universitat Rovira i Virgili (URV), Reus, Spain
- Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain
| | - Bjarne Madsen Hardig
- Department of Clinical Sciences, Helsingborg, Medical Faculty, Lund University, Sweden
| | - Youcef Azeli
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
- Sistema d’Emergències Mèdiques de Catalunya, Spain
- Emergency Department, Sant Joan University Hospital, Reus, Spain
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Azeli Y, Barbería E, Fernández A, García-Vilana S, Bardají A, Hardig BM. Chest wall mechanics during mechanical chest compression and its relationship to CPR-related injuries and survival. Resusc Plus 2022; 10:100242. [PMID: 35592875 PMCID: PMC9112017 DOI: 10.1016/j.resplu.2022.100242] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/20/2022] Open
Abstract
Aim To determine compression force variation (CFV) during mechanical cardiopulmonary resuscitation (CPR) and its relationship with CPR-related injuries and survival. Methods Adult non-traumatic OHCA patients who had been treated with mechanical CPR were evaluated for CPR-related injuries using chest X-rays, thoracic computed tomography or autopsy. The CFV exerted by the LUCAS 2 device was calculated as the difference between the maximum and the minimum force values and was categorised into three different groups (high positive CFV ≥ 95 newton (N), high negative CFV ≤ -95 N, and low variation for intermediate CFV). The CFV was correlated with the CPR injuries findings and survival data. Results Fifty-two patients were included. The median (IQR) age was 57 (49-66) years, and 13 (25%) cases survived until hospital admission. High positive CFV was found in 21 (40.4%) patients, high negative CFV in 9 (17.3%) and a low CFV in 22 (42.3%). The median (IQR) number of rib fractures was higher in the high positive and negative CFV groups compared with the low CFV group [7(1-9) and 9 (4-11) vs 0 (0-6) (p = 0.021)]. More bilateral fracture cases were found in the high positive and negative CFV groups [16 (76.2%) and 6 (66.7%) vs 6 (27.3%) (p = 0.004)]. In the younger half of the sample more patients survived until hospital admission in the low CFV group compared with the high CFV groups [5 (41.7%) vs 1 (7.1%) (p = 0.037)]. Conclusions High CFV was associated with ribcage injuries. In the younger patients low CFV was associated with survival until hospital admission.
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Affiliation(s)
- Youcef Azeli
- Sistema d’Emergències Mèdiques de Catalunya, Spain
- Emergency Department, Sant Joan University Hospital, Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
| | - Eneko Barbería
- Pathology Service, Institute of Legal Medicine and Forensic Sciences of Catalonia, Tarragona, Spain
- Rovira i Virgili University, Tarragona, Spain
| | - Alberto Fernández
- Universitat Rovira i Virgili, Departament d’Enginyeria Química, Tarragona, Spain
| | - Silvia García-Vilana
- Escola d’Enginyeria de Barcelona Est, Universitat Politècnica de Catalunya, Spain
| | - Alfredo Bardají
- Rovira i Virgili University, Tarragona, Spain
- Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain
| | - Bjarne Madsen Hardig
- Department of Clinical Sciences, Medical Faculty, Lund University, Helsingborg, Sweden
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Yoshimiya M, Ueda T, Ogoshi T, Zangpo D, Nakatome M, Iino M. Estimation of Postcardiac Arrest Interval Based on Atrial Cavity Density in Postmortem Computed Tomography. Yonago Acta Med 2022; 65:8-13. [DOI: 10.33160/yam.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Motoo Yoshimiya
- Department of Disaster and Emergency Medicine, Tottori University Hospital, Yonago 683-8504, Japan
| | - Takahiro Ueda
- Department of Disaster and Emergency Medicine, Tottori University Hospital, Yonago 683-8504, Japan
| | - Tomofumi Ogoshi
- Department of Disaster and Emergency Medicine, Tottori University Hospital, Yonago 683-8504, Japan
| | - Dawa Zangpo
- Division of Forensic Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Masato Nakatome
- Division of Forensic Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Morio Iino
- Division of Forensic Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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Optimizing hemodynamic function during cardiopulmonary resuscitation. Curr Opin Crit Care 2021; 27:216-222. [PMID: 33769419 DOI: 10.1097/mcc.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review is to provide an update on hemodynamics during cardiopulmonary resuscitation (CPR) and to describe emerging therapies to optimize perfusion. RECENT FINDINGS Cadaver studies have shown large inter-individual variations in blood distribution and anatomical placement of the heart during chest compressions. Using advanced CT techniques the studies have demonstrated atrial and slight right ventricular compression, but no direct compression of the left ventricle. A hemodynamic-directed CPR strategy may overcome this by allowing individualized hand-placement, drug dosing, and compression rate and depth. Through animal studies and one clinical before-and-after study head-up CPR has shown promising results as a potential strategy to improve cerebral perfusion. Two studies have demonstrated that placement of an endovascular balloon occlusion in the aorta (REBOA) can be performed during ongoing CPR. SUMMARY Modern imaging techniques may help increase our understanding on the mechanism of forward flow during CPR. This could provide new information on how to optimize perfusion. Head-up CPR and the use of REBOA during CPR are novel methods that might improve cerebral perfusion during CPR; both techniques do, however, still await clinical testing.
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Olszynski PA, Bryce R, Hussain Q, Dunn S, Blondeau B, Atkinson P, Woods R. Use of a Simple Ultrasound Device to Identify the Optimal Area of Compression for Out-of-Hospital Cardiac Arrest. Cureus 2021; 13:e12785. [PMID: 33489641 PMCID: PMC7815272 DOI: 10.7759/cureus.12785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 12/26/2022] Open
Abstract
Background Despite automated defibrillation and compression-first resuscitation, out-of-hospital cardiac arrest (OHCA) survival remains low. Resuscitation guidelines recommend that chest compressions should be done over the lower half of the sternum, but evidence indicates that this is often associated with outflow obstruction. Emerging studies suggest that compression directly over the left ventricle (LV) may improve survival and outcomes, but rapid and reliable localization of the LV is a major obstacle for those first responding to OHCA. This study aimed to determine if a simplified, easy-to-use ultrasound device (bladder scanner) can reliably locate the heart when applied over the intercostal spaces of the anterior thorax in supine patients. Furthermore, we sought to describe the association between largest scan volumes and underlying cardiac anatomy with particular attention to the long axis of the LV. Methodology We recruited healthy male and female volunteers over 40 years of age. Using a bladder scanner to evaluate the left sternal border and mid-clavicular lines, we determined the maximal scan volumes at 10 intercostal spaces for each participant. Cardiac ultrasound was then used to evaluate the corresponding underlying cardiac anatomy and determine the area overlying the long-axis view of the LV. Descriptive statistics (means with standard deviations [SD], medians with interquartile ranges, and frequencies with proportions) were used to quantify demographic information, typical scan volumes across the chest, the frequencies of the best long-axis LV view location. This was then repeated for left sternal border assessments only. Kappa was determined when evaluating agreement between the largest left sternal border scan volume and the best long-axis LV view location. Results The long-axis LV was the predominant structure underlying the largest scan volume in 39/51 (76.5%) patients. When limited to left sternal border volumes only, the long axis of the LV was underlying the maximum volume intercostal space in 46/51 (90.2%; 95% confidence interval [CI]: 78.6%, 96.7%). The largest left sternal border scan volumes were located over the best long-axis LV view in 39/51 (76.5%, 95% CI: 62.5%, 87.2%) of the study participants with a Kappa statistic of 0.68 (95% CI: 0.52, 0.84; p < 0.0001). Conclusions In this cross-sectional study of healthy volunteers, an easy-to-use ultrasound device (bladder scanner) was able to reliably localize the heart. Largest scan volumes over the left sternal border showed substantial agreement with the intercostal space overlying the long axis of the LV. Further investigations are warranted to determine if such localization is reliable in cardiac arrest patients.
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Affiliation(s)
| | - Rhonda Bryce
- Clinical Research Support Unit, University of Saskatchewan, Saskatoon, CAN
| | - Qasim Hussain
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
| | - Stephanie Dunn
- Faculty of Nursing, University of Regina, Saskatoon, CAN
| | - Brandon Blondeau
- School of Health Sciences, Saskatchewan Polytechnic, Saskatoon, CAN
| | - Paul Atkinson
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
- Emergency Medicine, Dalhousie, Halifax, CAN
| | - Robert Woods
- Emergency Medicine, University of Saskatchewan, Saskatoon, CAN
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