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Pressures generated by ribcage and abdominal compressions during cardiopulmonary resuscitation

  • Biomechanics
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Abstract

When the ribcage and abdomen are compressed during cardiopulmonary resuscitation (CPR), the effect on intrathoracic pressure, and therefore on haemodynamics, cannot be quantitatively predicted without a physiologically based mathematical model of chest wall dynamics. Using such a model, we compared model simulations of pleural Ppl and abdominal Pab pressures with those from dog experiments in which the compression of the ribcage was delayed from 0 to 500 ms after compression of the abdomen. Integrals of Ppl and transdiaphragmatic pressure, Pdi=Pab−Ppl, over their positive and negative values during a cycle were chosen as indices of driving pressures for cardiac output. Both from the model output and experimental data, we found that the positive ppl integral PPI tends to increase with a longer delay between ribcage and abdominal compressions. The negative Ppl integral NPI, however, tends to decrease according to the model predictions and data. Furthermore, the positive and negative integrals of Pdl also tend to change with delay time in the opposite way, as shown by both the model simulations and the experiments. Our results show that chest wall tissues modify the externally applied pressures, thereby not allowing us to use the externally applied pressure sources directly as the driving pressure of the cardiovascular system under study. The optimal conditions for haemodynamics during CPR require a compromise between the positive and negative integral indices. Prediction of the optimal haemodynamics from externally applied pressures requires the coupling of appropriate physiological models of chest wall dynamics and haemodynamics.

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Abbreviations

P :

pressure (force/area)

V :

volume

Z :

impedance function

σ:

stress (force/area)

\(\hat \sigma \) :

active stress (force/area)

ϕ:

diaphragm position ratio,A rt /A rc

Φ:

area ratio,A rd /(A rb +A rd )

X i :

distance of structurei

δX i :

displacement from operating point of structurei

K 1i ,K 2i ,K 3i ,K 4i :

empirical constants of pressure/displacement relationship of structure

alv :

alveolar

ab :

abdomen

ao :

airway opening

aw :

airway

di :

diaphragm

l :

lung

pl :

pleural

rc :

rib cage

rd :

diaphragm apposed ribcage

rl :

moving lung apposed ribcage

vr :

ribcage vest

va :

abdominal vest

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Authors and Affiliations

  1. Cardiovascular Research Group, Rappaport Family Institute for Research in the Medical Sciences, Department of Physiology & Biophysics, Technion-Israel institute of Technology, PO Box 9697, Haifa, Israel

    S. A. Ben-Haim

  2. Heart System Research Center, Julius Silver Institute for Bio-Medical Engineering, Department of Biomedical Engineering, Technion-Israel Institute of Technology, 32 000, Haifa, Israel

    R. Shofti & U. Dinnar

  3. Department of Biomedical Engineering, Case Western Researve University and Veterans Administration Medical Center, 44106, Cleveland, OH, USA

    G. M. Saidel

Authors
  1. S. A. Ben-Haim
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  2. R. Shofti
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  3. U. Dinnar
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  4. G. M. Saidel
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Ben-Haim, S.A., Shofti, R., Dinnar, U. et al. Pressures generated by ribcage and abdominal compressions during cardiopulmonary resuscitation. Med. Biol. Eng. Comput. 28, 43–49 (1990). https://doi.org/10.1007/BF02441676

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