External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

Hdl Handle:
http://hdl.handle.net/10147/298057
Title:
External cardiac compression may be harmful in some scenarios of pulseless electrical activity.
Authors:
Hogan, T S
Affiliation:
Department of Anaesthesia, UPMC Beacon Hospital, Sandyford, Dublin 18, Ireland. dr.tshogan@eircom.net
Citation:
External cardiac compression may be harmful in some scenarios of pulseless electrical activity. 2012, 79 (4):445-7 Med. Hypotheses
Journal:
Medical hypotheses
Issue Date:
Oct-2012
URI:
http://hdl.handle.net/10147/298057
DOI:
10.1016/j.mehy.2012.06.018
PubMed ID:
22809840
Abstract:
Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient's cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless electrical activity. Investigation using a variety of animal models of pulseless electrical activity produced by different shock-inducing mechanisms is required to provide an evidence base for resuscitation guidelines.
Item Type:
Article
Language:
en
MeSH:
Animals; Cardiac Output; Cardiopulmonary Resuscitation; Electrophysiological Phenomena; Heart Arrest; Heart Massage; Humans; Models, Cardiovascular; Pulse; Shock, Cardiogenic; Stroke Volume; Vascular Resistance; Vasodilation
ISSN:
1532-2777

Full metadata record

DC FieldValue Language
dc.contributor.authorHogan, T Sen_GB
dc.date.accessioned2013-08-13T09:04:20Z-
dc.date.available2013-08-13T09:04:20Z-
dc.date.issued2012-10-
dc.identifier.citationExternal cardiac compression may be harmful in some scenarios of pulseless electrical activity. 2012, 79 (4):445-7 Med. Hypothesesen_GB
dc.identifier.issn1532-2777-
dc.identifier.pmid22809840-
dc.identifier.doi10.1016/j.mehy.2012.06.018-
dc.identifier.urihttp://hdl.handle.net/10147/298057-
dc.description.abstractPulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient's cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless electrical activity. Investigation using a variety of animal models of pulseless electrical activity produced by different shock-inducing mechanisms is required to provide an evidence base for resuscitation guidelines.en_GB
dc.language.isoenen
dc.rightsArchived with thanks to Medical hypothesesen_GB
dc.subject.meshAnimals-
dc.subject.meshCardiac Output-
dc.subject.meshCardiopulmonary Resuscitation-
dc.subject.meshElectrophysiological Phenomena-
dc.subject.meshHeart Arrest-
dc.subject.meshHeart Massage-
dc.subject.meshHumans-
dc.subject.meshModels, Cardiovascular-
dc.subject.meshPulse-
dc.subject.meshShock, Cardiogenic-
dc.subject.meshStroke Volume-
dc.subject.meshVascular Resistance-
dc.subject.meshVasodilation-
dc.titleExternal cardiac compression may be harmful in some scenarios of pulseless electrical activity.en_GB
dc.typeArticleen
dc.contributor.departmentDepartment of Anaesthesia, UPMC Beacon Hospital, Sandyford, Dublin 18, Ireland. dr.tshogan@eircom.neten_GB
dc.identifier.journalMedical hypothesesen_GB
dc.description.fundingNo fundingen
dc.description.provinceLeinsteren
dc.description.peer-reviewpeer-reviewen

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