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Published on: May 19, 2021
Sternal wall pressure comparable to leaning during CPR impacts intrathoracic pressure and haemodynamics in
Andrew C Glatz1, Akira Nishisaki, Dana E Niles
1Division of Cardiology, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, United States.
Insights
Sternal forces during cardiopulmonary resuscitation (CPR) in children increase intrathoracic airway pressures and right atrial pressure while decreasing coronary perfusion pressure. These findings highlight potential clinical implications for pediatric CPR effectiveness and safety.
Area of Science:
- Pediatric Cardiology
- Cardiopulmonary Resuscitation Research
- Anesthesiology
Background:
- Leaning during cardiopulmonary resuscitation (CPR) negatively impacts hemodynamics and intrathoracic airway pressures (ITP) in adults and animal models.
- The effects of such forces on pediatric hemodynamics and ITP remain understudied.
Purpose of the Study:
- To investigate the impact of sternal forces (SF), simulating leaning during CPR, on hemodynamic parameters and ITP in anesthetized children.
- To characterize the relationship between increasing SF and changes in cardiovascular function and airway pressures.
Main Methods:
- The study included 20 anesthetized children (6 months to 8 years) who underwent cardiac catheterization post-heart transplant.
- Hemodynamic data and ITP were recorded at baseline and during incremental increases in sternal force (10% and 20% of body weight).
Main Results:
- Significant increases in mean right atrial pressure, pulmonary capillary wedge pressure, and ITP were observed with rising SF (p<0.001).
- Aortic systolic pressure (p=0.014) and coronary perfusion pressure (p<0.001) significantly decreased as SF increased.
Conclusions:
- In asymptomatic, anesthetized pediatric cardiac transplant recipients, sternal forces akin to CPR leaning increase ITP and right atrial pressure.
- These forces also reduce coronary perfusion pressure, suggesting potential clinical significance during pediatric CPR that warrants further investigation.
Aim:
Force due to leaning during cardiopulmonary resuscitation (CPR) negatively affects haemodynamics and intrathoracic airway pressures (ITP) in animal models and adults, but has not been studied in children. We sought to characterize the effects of sternal force (SF) comparable to leaning force on haemodynamics and ITP in anaesthetized children.
Methods:
Children (6 months to 8yrs) presenting for routine haemodynamic cardiac catheterization with anaesthesia and mechanical ventilation >6 months after cardiac transplant were studied. Haemodynamics and ITP were measured before and during incremental increases in SF of 10% and 20% body weight.
Results:
20 subjects (5.4±1.7yrs of age and 18.3±3.3kg) were studied. Mean right atrial pressure (6.5±2.6 at baseline vs. 7.7±2.6 at 10% SF vs. 8.6±2.7mmHg at 20% SF), mean pulmonary capillary wedge pressure (10.2±2.9 at baseline vs. 11±3.3 at 10% SF vs. 11.8±3.4mmHg at 20% SF) and ITP (16.3±3.2 at baseline vs. 17.9±3.9 at 10% SF vs. 19.5±4cm H2O) all increased significantly with incremental SF (p<0.001 for all). Aortic systolic pressure (85±10mmHg at baseline vs. 83±10mmHg at 10% SF vs. 82±10mmHg at 20% SF, p=0.014) and coronary perfusion pressure (42±7mmHg at baseline vs. 39±7mmHg at 10% SF vs. 38±7mmHg at 20% SF, p<0.001) both decreased significantly with incremental SF.
Conclusions:
In asymptomatic, anaesthetized children after cardiac transplantation, sternal forces comparable to leaning previously reported to occur during CPR elevate ITP and right atrial pressure and decrease coronary perfusion pressure. These haemodynamic effects may be clinically important during CPR and warrant further study.
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