Michael Otlewski

Rhythmic abdominal compression CPR ventilates without supplemental breaths and provides effective blood circulation

OBJECTIVES Standard chest-compression CPR has an out-of-hospital resuscitation rate of less than 10% and can result in rib fractures or mouth-to-mouth transfer of infection. Recently, we introduced a new CPR method that utilizes only rhythmic abdominal compressions (OAC-CPR). The present study compares ventilation and hemodynamics produced by chest and abdominal compression CPR. METHODS Twelve swine (29-34kg) were anesthetized, intubated and allowed to breathe spontaneously. Physiologic dead space, resting tidal volume, compression-induced lung air flow, and blood pressures were recorded. Ventricular fibrillation (VF) was electrically induced and subjects were treated with either standard CPR or OAC-CPR at various force and rate settings. Minute alveolar ventilation (MAV) and mean coronary perfusion pressure (CPP) were compared. RESULTS For OAC-CPR, ventilation per compression tended to increase with increasing force and decreasing rate. Chest only compressions produced no MAV, while OAC-CPR at 80cycles/min or less, matched the MAV for spontaneous respiration. For all rates, abdominal compressions met, or exceeded, the CPP of chest compressions performed at 100lbs. CONCLUSIONS OAC-CPR generated ventilatory volumes significantly greater than the dead space and produced equivalent, or larger, CPP than with chest compressions. Thus, OAC-CPR ventilates a subject, eliminating the need for mouth-to-mouth breathing, and effectively circulates blood during VF without breaking ribs. Furthermore, this technique is simple to perform, can be administered by a single rescuer, and should reduce bystander reluctance to administer CPR.

Heel and Calf Capillary-Support Pressure in Lithotomy Positions

• A THREE-PART ANALYSIS was undertaken to increase understanding of the occurrence of pressure ulcers in lithotomy positions. An innovative measuring device was used to determine capillary pressure. • ANKLE BLOOD PRESSURE was measured compared to ankle height in 11 participants. Ankle systolic and diastolic pressure decreased approximately 20 mmHg per foot of elevation. • CALF AND HEEL CAPILLARY-SUPPORT pressures were measured in 15 participants in the standard lithotomy position. Capillary-support pressure for the calf was substantially less than for the heel. • HEEL CAPILLARY-SUPPORT PRESSURES were measured in 16 participants in the high lithotomy position. As heel height increased, capillary-support pressure also increased. AORN J 81 (April 2005) 821–830.

CPR Degradation Diagram

During untreated ventricular fibrillation (VF), before CPR is applied, different bodily systems deteriorate at different rates. This paper describes the times when the EEG disappears, when respiratory arrest occurs, and when PD-PEA occurs. It also describes the frequency of VF waves over a 7-min period and how the frequency increases with good CPR.