Arrhythmias and conduction disturbance
Effect of Chest Compressions on Ventricular Activation

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External mechanical forces can cause ventricular capture and fibrillation (i.e., commotio cordis). In animals, we showed that chest compressions (CCs) can also cause the phenomenon. The aim of the present study was to determine whether ventricular capture by CCs occurs in humans. Electronic rhythm strips were analyzed in 31 cases of out-of-hospital cardiac arrest. The timing of the CCs was identified from the changes in thoracic impedance between the defibrillator pads. Ventricular capture was defined as QRS complexes of similar morphology occurring intermittently but synchronized with the CC artifact and impedance waveform. Only intermittent ventricular capture was identified to avoid misclassifying constant motion artifacts or intrinsic rhythm as ventricular capture. Of the 29 patients who received CCs for ≥1 minute, minimal or stable motion artifact was present in 24. Intermittent ventricular capture was found in 7 of the 24 patients. In the patients with ventricular capture, the number of ventricular activations (from ventricular capture and native beats) was greater during the CCs than when the CCs was not being performed (18 ± 8.9 vs 9.7 ± 4.0 activations in 15 seconds, p = 0.01). However, in patients without ventricular capture, they were similar (6.8 ± 8.2 vs 7.2 ± 8.8 activations in 15 seconds, p = 0.47). Refibrillation occurred in 22 patients; it began during the CCs in 16 and closely following their initiation in 3. In conclusion, CCs during cardiopulmonary resuscitation can electrically stimulate the heart. Additional studies evaluating the effect of ventricular capture on cardiopulmonary resuscitation outcomes, its relation to refibrillation, and methods to prevent or time ventricular capture by CCs are warranted.

Section snippets

Methods

Patients who sustained out-of-hospital cardiac arrest in the Greater Birmingham, Alabama area from January to August 2008 were studied. The subjects had been enrolled in the Resuscitation Outcomes Consortium-Cardiac Arrest Population-based Registry (ROC-Epistry). The Resuscitation Outcomes Consortium is a clinical research network consisting of 10 clinical centers in the United States and Canada organized to conduct randomized trials pertaining to trauma and out-of-hospital sudden cardiac

Results

The rhythm strips and thoracic impedance measurement of 31 patients sustaining out-of-hospital sudden cardiac arrest were studied. The initial rhythm was VF or pulseless ventricular tachycardia in 21 patients, pulseless electrical activity in 7, and asystole in 3. In 2 patients, a return of spontaneous circulation was achieved without the need for CCs. All the remaining patients received CCs for ≥1 minute.

Of the 29 patients who received CCs, 24 had ≥1 segment lasting >30 seconds in which the

Discussion

In most patients, the rhythm strips obtained during CPR contain segments with relatively minor motion artifact or a stable, oscillating motion artifact that allows visualization of the cardiac rhythm. The major finding of the present study is that ventricular capture occurred synchronously with CCs in 29% of these patients. Although it was not possible to obtain the definitive evidence of direct cardiac recordings, our results provide strong evidence that the mechanical force generated by CCs

Acknowledgment

We thank Kate Sreenan for assistance in preparing the report.

References (23)

  • F. Bode et al.

    Ventricular fibrillation induced by stretch pulse: implications for sudden death due to commotio cordis

    J Cardiovasc Electrophysiol

    (2006)
  • Cited by (13)

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      Refibrillation was all the more delayed as the BLS team was late in resuming post-shock CC. It is well-documented that the force generated by CC can cause ventricular capture followed by a VF recurrence11,17; that delaying CPR after the shock can result in later VF recurrences13; and that most VF recurrences occur within 10 s of initiating CC.9 In general, it may be plausible that CPR could be linked to VF recurrence.18

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    • Filtering mechanical chest compression artefacts from out-of-hospital cardiac arrest data

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      Filtering successfully removes large mechanical compression artefacts of very different waveforms. However, the examples in the figure show three possible sources of erroneous diagnoses after filtering: QRS like activity during VF maybe caused by ventricular capture during compressions,26 VF like filtering residues of large compression artefacts during ASY or ORG rhythms, and ORG rhythms of rates compatible with the chest compression rate (1:2 in the example) which are therefore removed or distorted by the compression artefact filter. Many filtering techniques have been proposed to remove compression artefacts from the ECG during manual compressions.5,27,17,9

    • To compress or not to compress; That is the question

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    This work is supported by grants HL 66256 and 77881 from the National Institutes of Health, Bethesda, Maryland.

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