Abstract

Objective: To discover design principles underlying the optimal waveforms for external chest and abdominal compression and decompression during cardiac arrest and CPR. Method: A 14-compartment mathematical model of the human cardiopulmonary system is used to test successive generations of randomly mutated external compression waveforms during cardiac arrest and resuscitation. Mutated waveforms that produced superior mean perfusion pressure became parents for the next generation. Selection was based upon either systemic perfusion pressure (SPP=thoracic aortic minus right atrial pressure) or upon coronary perfusion pressure (CPP=thoracic aortic pressure minus myocardial wall pressure). After simulations of 64,414 individual CPR episodes, 40 highly evolved waveforms were characterized in terms of frequency, duty cycle, and phase. A simple, practical compression technique was then designed by combining evolved features and a constant rate of 80/min and duty cycle of 50%. Results: All ultimate surviving waveforms included reciprocal compression and decompression of the chest and the abdomen to the maximum allowable extent. The evolved waveforms produced 1.5 to 3 times the mean perfusion pressure of standard CPR and greater perfusion pressure than other forms of modified CPR reported heretofore, including ACD+ITV and IAC-CPR. When SPP was maximized by evolution, the chest compression/abdominal decompression phase was near 70% of cycle time. When CPP was maximized, the abdominal compression/chest decompression phase was near 30% of cycle time. Near-maximal SPP/CPP of 60/21 mmHg (forward flow 3.8 L/min) occurred at a compromise compression frequency of 80/min and duty cycle for chest compression of 50%. Conclusions: Optimized waveforms for thoraco-abdominal compression and decompression include previously discovered features of active decompression and interposed abdominal compression. These waveforms can be utilized by manual (Lifestick-like) and mechanical (vest-like) devices to achieve short periods of near normal blood perfusion noninvasively during cardiac arrest.

Comments

This is the author accepted manuscript of Charles F. Babbs, Design of near-optimal waveforms for chest and abdominal compression and decompression in CPR using computer-simulated evolution, Resuscitation, 68, 277-293, 2006. http://dx.doi.org/10.1016/j.resuscitation.2005.06.025. The AAM is CC-BY-NC-ND.

Keywords

ACD-CPR, Cardiopulmonary resuscitation (CPR); Coronary perfusion pressure; Device; IAC-CPR, Mathematical model, Vest CPR

Date of this Version

2-15-2005

DOI

10.1016/j.resuscitation.2005.06.025

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