Blood flow with ventilation alone in a child with cardiac arrest

Recent investigations suggest that increased intrathoracic pressure causing compression of the heart and great vessels in the thorax plays an important role in providing blood flow during cardiopulmonary resuscitation. This communication reports the case of a four-year-old asphyxiated girl found to have a small amount of blood flow detected by unidirectional doppler during bag-valve/endotracheal tube ventilation alone during resuscitation. Although there was no evidence that ventilation alone resulted in quantitatively significant blood flow, that blood flow occurred at all with modest changes in only intrathoracic pressure provides corroborative physiological evidence that changes in intrathoracic pressure are important in the mechanism of blood flow during cardiopulmonary resuscitation.