Arrhythmias and conduction disturbanceEffect of Chest Compressions on Ventricular Activation
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)
- et al.
Endocardial mapping of ventricular fibrillation in commotio cordis
Heart Rhythm
(2008) - et al.
Upper and lower limits of vulnerability to sudden arrhythmic death with chest-wall impact (commotio cordis)
J Am Coll Cardiol
(2003) Mechanically induced sudden death in chest wall impact (commotio cordis)
Prog Biophys Mol Biol
(2003)- et al.
Mechanically induced ventricular fibrillation (commotio cordis)
Heart Rhythm
(2007) - et al.
Transthoracic impedance used to evaluate performance of cardiopulmonary resuscitation during out of hospital cardiac arrest
Resuscitation
(2008) - et al.
The sign of four and the SDNN of one of three
Heart Rhythm
(2006) - et al.
Ventricular fibrillation is not provoked by chest compression during post-shock organized rhythms in out-of-hospital cardiac arrest
Resuscitation
(2005) - et al.
Automated external defibrillation versus manual defibrillation for prolonged ventricular fibrillation: lethal delays of chest compressions before and after countershocks
Ann Emerg Med
(2003) - et al.
VF recurrence: characteristics and patient outcome in out-of-hospital cardiac arrest
Resuscitation
(2003) - et al.
An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis)
N Engl J Med
(1998)
Ventricular fibrillation induced by stretch pulse: implications for sudden death due to commotio cordis
J Cardiovasc Electrophysiol
Cited by (13)
Contributing factors to early recurrence of ventricular fibrillation during out-of-hospital cardiac arrest: An observational retrospective study
2020, ResuscitationCitation Excerpt :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
Non-optogenetic approaches for leadless cardiac pacing: Mechanically induced excitation for extracorporeal control of cardiac rhythm
2020, Emerging Technologies for Heart Diseases: Volume 2: Treatments for Myocardial Ischemia and ArrhythmiasFiltering mechanical chest compression artefacts from out-of-hospital cardiac arrest data
2016, ResuscitationCitation Excerpt :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
2012, American Journal of Cardiology