The quality of chest compressions during cardiopulmonary resuscitation overrides importance of timing of defibrillation

Giuseppe Ristagno, Wanchun Tang, Yun Te Chang, Dawn B. Jorgenson, James K. Russell, Lei Huang, Tong Wang, Shijie Sun, Max Harry Weil

Research output: Contribution to journalArticlepeer-review

Abstract

Background: We address the quality of chest compressions and the impact on initial defibrillation or initial chest compressions after sudden death. Methods: Ventricular fibrillation was induced by occlusion of the left anterior descending coronary artery in 24 domestic pigs with a mean (± SD) weight of 40 ± 2 kg. Cardiac arrest was left untreated for 5 min. Animals were then randomized to receive chest compressions-first or defibrillation-first and were further randomized to "optimal" or "conventional" chest compressions. A total of four groups of animals were investigated using a factorial design. For optimal chest compressions, the anterior posterior diameter of the chest was reduced by 25%, representing approximately 6 cm. Only 70% of this depth, or approximately 4.2 cm, represented conventional chest compressions. Chest compressions were delivered with a mechanical chest compressor. Defibrillation was attempted with a single biphasic 150-J shock. Postresuscitation myocardial function was echocardiographically assessed. Results: Coronary perfusion pressures and end-tidal PCO3 were significantly lower with conventional chest compressions. With optimal chest compressions, either as an initial intervention or after defibrillation, each animal was successfully resuscitated. Fewer shocks were required prior to the return of spontaneous circulation after initial optimal chest compressions. No animals were resuscitated when conventional chest compressions preceded the defibrillation attempt. When defibrillation was attempted as the initial intervention followed by conventional chest compressions, two of six animals were resuscitated. Conclusions: In this animal model of cardiac arrest, it was the quality of the chest compressions, rather then the priority of either initial defibrillation or initial chest compressions, that was the predominant determinant of successful resuscitation.

Original languageEnglish
Pages (from-to)70-75
Number of pages6
JournalChest
Volume132
Issue number1
DOIs
Publication statusPublished - Jul 2007

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Chest compression
  • Defibrillation
  • Survival
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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