4/5/2023 0 Comments Cpr injury 2019 journalyThe sternal recoil during the decompression phase decreases intrathoracic pressure, and this is crucial to maintaining venous return and therefore cardiac output. The generation of cardiac output during CPR is mainly based on two complementary theories: the theory of the thoracic pump and the theory of the cardiac pump ( Chalkias et al., 2019). This would allow the initiation of advanced therapies when indicated-such as CPR with extracorporeal membrane oxygenation (ECMO) ( Roncon-Albuquerque et al., 2018). Otherwise, CPR assisted by mechanical compressors allows prolonging the resuscitation and maintaining its quality. The use of mechanical compressors has become widespread, but this has not led to improved survival from cardiac arrest ( Gates et al., 2015), and several studies have described an increased incidence of serious thoracic injuries (STIs) after their use ( Smekal et al., 2014 Koster et al., 2017). The depth of chest compressions, advanced age, female sex, and longer CPR duration are the main risk factors for a thoracic injury ( Ram et al., 2018), and they have been associated with a low rate of return of spontaneous circulation ( Kashiwagi et al., 2015). Thoracic injuries secondary to CPR are common ( Kralj et al., 2015). The guidelines recommend compressions at a depth between 5 and 6 cm for a medium-sized adult, at a frequency of 100 per min, and ensuring the return of the sternum to its original position in the decompression phase ( Perkins et al., 2015). Chest compressions during CPR should be started by placing the heel of the hand over the lower half of the sternum. That is why they are the most important maneuver performed during CPR and should be performed as early as possible without fear of causing harm to the patient. Thoracic compressions ensure cardiac output during cardiopulmonary resuscitation (CPR). The survival of patients who suffer cardiac arrest is barely over 10%, and improving this represents a great challenge ( Gräsner et al., 2016). A better understanding of the effects of STIs during CPR, and the study of avoidable injuries, can help to improve the effectiveness of chest compressions and the survival in cardiac arrest. The thorax with STIs is more vulnerable to the adverse hemodynamic effects of leaning, hyperventilation, and left ventricular outflow tract obstruction during CPR. The representation of STIs on the CD shows a decrease in the intrathoracic negative pressure and a functional residual capacity decrease during the thoracic decompression, leading to a venous return impairment. STIs produce a decrease in the compliance of the chest wall and lung. The Campbell diagram (CD) is a theoretical framework that integrates the lung and chest wall pressure-volume curves, allowing us to assess the consequences of STIs on respiratory mechanics and hemodynamics. Little is known about their hemodynamic effects, so a review of this emerging concept is necessary. Serious thoracic injuries (STIs) are common during CPR, and they can change the shape and mechanics of the thorax. Their quality performance is key to achieving the return of spontaneous circulation. 8School of Medicine, Rovira i Virgili University, Tarragona, SpainĬhest compressions during cardiopulmonary resuscitation (CPR) generate cardiac output during cardiac arrest.7Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain.6Intensive Care Department, University Hospital of SAS Jerez, Jerez de la Frontera, Spain.5School of Medicine and Health Sciences, International University of Catalonia (IUC), Barcelona, Spain.4Clinical Management Anaesthesiology Unit, Resuscitation and Pain Therapy, Juan Ramón Jiménez Hospital, Huelva, Spain.3Institut d’Investigació Sanitari Pere Virgili, Tarragona, Spain.2Emergency Department, Sant Joan University Hospital, Reus, Spain.1Sistema d’Emergències Mèdiques de Catalunya, Barcelona, Spain.Youcef Azeli 1,2,3 *, Juan Víctor Lorente Olazabal 4,5, Manuel Ignacio Monge García 6 and Alfredo Bardají 7,8
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