Luca Lucchetta1, Timothy N Kwan2, Junko Kosaka3, Aiko Tanaka4, Glenn M Eastwood2, Matthew Chan2, Johan Martensson5, Clive N May6, Rinaldo Bellomo7. 1. Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University of Milan, Milan, Italy. 2. Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia. 3. Department of Anesthesiology, Okayama Univerisyt, Okayama, Japan. 4. Department of Anesthesiology, Osaka University, Osaka, Japan. 5. Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden. 6. Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Melbourne, Australia. 7. Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Melbourne, Australia; School of Medicine, University of Melbourne, Parkville, Melbourne Australia. Electronic address: rinaldo.bellomo@austin.org.au.
Abstract
BACKGROUND: The carotid artery blood flow (CABF) or cerebral blood flow (CBF) achieved with current techniques of cardiac compression in humans are unknown. Animal experiments may provide useful information on such flows and on possible techniques to optimize them. OBJECTIVES: To obtain an estimate of carotid and cerebral blood flows during cardiac compression with different techniques. METHODS: We performed a systematic review of all studies in the English literature that measured the CABF and/or CBF during cardiac compression in experimental models of cardiac arrest, expressed as a percentage of baseline (pre-arrest) values. We compared the effect of vasopressor use, thoracic compression technique, pre-arrest infusion and animal model on maximum blood flows using standard statistical methodologies. RESULTS: Overall, 133 studies were reviewed. Of these, 45 studies provided information only on CABF; 77 only on CBF, and 11 studies on both flows. The overall weighted mean (±SD) CABF was 35.2 ± 27.7% of baseline. Porcine studies showed lower CABF when vasopressors were used (p = 0.0002). Studies of CBF reported a weighted mean value of 66.5 ± 48.5% of baseline. Adjunctive vasopressor therapy significantly increased CBF (p = 0.007), as did fluid administration (P = 0.049). In studies reporting both CABF and CBF, the median CABF/CBF ratio was 0.67 (range 0.21-1.96). CONCLUSIONS: During experimental cardiac compression, compared to baseline, CABF appears to decrease much more than CBF. However results should be regarded with caution. They are affected by ancillary interventions and measurement methods, variability is marked and, in experiments measuring CABF and CBF simultaneously, their ratios range well outside physiologically plausible values.
BACKGROUND: The carotid artery blood flow (CABF) or cerebral blood flow (CBF) achieved with current techniques of cardiac compression in humans are unknown. Animal experiments may provide useful information on such flows and on possible techniques to optimize them. OBJECTIVES: To obtain an estimate of carotid and cerebral blood flows during cardiac compression with different techniques. METHODS: We performed a systematic review of all studies in the English literature that measured the CABF and/or CBF during cardiac compression in experimental models of cardiac arrest, expressed as a percentage of baseline (pre-arrest) values. We compared the effect of vasopressor use, thoracic compression technique, pre-arrest infusion and animal model on maximum blood flows using standard statistical methodologies. RESULTS: Overall, 133 studies were reviewed. Of these, 45 studies provided information only on CABF; 77 only on CBF, and 11 studies on both flows. The overall weighted mean (±SD) CABF was 35.2 ± 27.7% of baseline. Porcine studies showed lower CABF when vasopressors were used (p = 0.0002). Studies of CBF reported a weighted mean value of 66.5 ± 48.5% of baseline. Adjunctive vasopressor therapy significantly increased CBF (p = 0.007), as did fluid administration (P = 0.049). In studies reporting both CABF and CBF, the median CABF/CBF ratio was 0.67 (range 0.21-1.96). CONCLUSIONS: During experimental cardiac compression, compared to baseline, CABF appears to decrease much more than CBF. However results should be regarded with caution. They are affected by ancillary interventions and measurement methods, variability is marked and, in experiments measuring CABF and CBF simultaneously, their ratios range well outside physiologically plausible values.
Authors: Sharda Udassi; Ikram U Haque; Dalia Lopez-Colon; Andre Shih; Dhanya Vasudeva; Giridhar Kaliki-Venkata; Michael Weiss; Arno L Zaritsky; Jai P Udassi Journal: Resusc Plus Date: 2021-04-14