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New Developments in Cardiopulmonary Resuscitation FREE

John M. Luce, MD; Jeffrey M. Cary, MD; Brian K. Ross, PhD; Bruce H. Culver, MD; John Butler, MD
[+] Author Affiliations

Reprint requests to Division of Respiratory Diseases, RM-12, University of Washington, Seattle, WA 98195 (Dr Luce).


JAMA. 1980;244(12):1366-1370. doi:10.1001/jama.1980.03310120052029
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The traditional concept of cardiopulmonary resuscitation (CPR) is that the heart is squeezed between the sternum and the spine during external cardiac massage to create a pressure gradient that forces blood from the heart to the periphery. Although the heart may actually be squeezed in some persons by this maneuver, a newer view of CPR holds that closed-chest compression produces a generalized rise in intrathoracic pressure that is applied to the pulmonary vascular bed as well as the heart. Thus, the heart does not serve primarily as a pump during external cardiac massage but instead acts as a conduit for blood from the lungs. Furthermore, flow into extrathoracic vessels depends on their tendency to remain open or to collapse: forward flow occurs across the head during CPR because a pressure gradient is developed between the carotid artery and the more compressible jugular vein. These ideas have potential clinical implications and greatly increase our understanding of the physiology of CPR.

(JAMA 244:1366-1370, 1980)

REFERENCES

II Kings 4:34 (KJV).
Comroe JH:  Retrospectroscope . Am Rev Respir Dis 119:308-808, 1979;.
Elam JO, Brown ES, Elder JD:  Artificial respiration by mouth-to-mask method . N Engl J Med 250:749-754, 1954;.
Kouwenhoven WB, Jude JR, Knickerbocker GG:  Closed-chest cardiac massage . JAMA 173:1064-1067, 1960;.
Jude JR, Kouwenhoven WB, Knickerbocker GG:  Cardiac arrest: Report of application of external cardiac massage on 118 patients . JAMA 178:1063-1070, 1961;.
Weale FE, Rothwell-Jackson RL:  The efficiency of cardiac massage . Lancet 1:990-992, 1962;.
MacKenzie GJ, Taylor SH, McDonald AH, et al:  Haemodynamic effects of external cardiac compression . Lancet 1:1342-1345, 1964;.
 Standards for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC), American Heart Association . JAMA 227( (suppl) ):833-868, 1974;.
Taylor GJ, Rubin R, Tucker M, et al:  External cardiac compression: A randomized comparison of mechanical and manual techniques . JAMA 240:644-646, 1978;.
Taylor GJ, Tucker WM, Greene HL, et al:  Importance of prolonged compression during cardiopulmonary resuscitation in man . N Engl J Med 296:1515-1517, 1977;.
Chandra N, Rudikoff M, Tsitlik J, et al:  Augmentation of carotid flow during cardiopulmonary resuscitation (CPR) in the dog by simultaneous compression and ventilation with high airway pressure , abstracted. Am J Cardiol 43:422, 1979;.
Chandra N, Rudikoff M, Weisfeldt ML:  Simultaneous chest compression and ventilation at high airway pressure during cardiopulmonary resuscitation . Lancet 1:175-178, 1980;.
Rudikoff MT, Maughan WL, Effron M, et al:  Mechanisms of blood flow during cardiopulmonary resuscitation . Circulation 61:345-352, 1980;.
Yin CP, Cohen JM, Tsitlik J, et al:  Arterial resistance to collapse: A determinant of peripheral flow resulting from high intrathoracic pressure , abstracted. Circulation 60( (suppl 2) ):196, 1979;.
Cohen JM, Anderson PO, Van Aswegen A, et al:  Timing of intrathoracic blood flow during resuscitation with high intrathoracic pressure , abstracted. Circulation 60( (suppl 2) ):196, 1979;.
Niemann JT, Garner D, Rosborough J, et al:  The mechanism of blood flow in closed chest cardiopulmonary resuscitation , abstracted. Circulation 60( (suppl 2) ):74, 1979;.
Sones FM:  Cine coronary angiography , in Hurst JW, Logue RB (eds): The Heart . New York, McGraw-Hill Book Co Inc, 1970;, pp 377-385.
Criley JM, Blaufuss AH, Kissel GL:  Cough-induced cardiac compression: Self-administered form of cardiopulmonary resuscitation . JAMA 236:1246-1250, 1976;.
Rossen R, Kabat H, Anderson JP:  Acute arrest of cerebral circulation in man . Arch Neurol Psychiat 50:510-528, 1943;.
Cary JM, Ross BK, Krugmire R, et al:  Coughing causes systemic blood flow , abstracted. Chest 74:332-333, 1978;.
Rosborough JP, Hausknecht M, Criley JM, et al:  Cardiac output during ventricular fibrillation in the coughing dog , abstracted. Presented at the American College of Cardiology meetings, March 9-13, 1980 .
Rabson J, Goldberg H, Bromberger-Barnea B, et al:  The use of a pneumatic vest to generate carotid flow in a canine model of circulatory arrest , abstracted. Circulation 60( (suppl 2) ):196, 1979;.

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II Kings 4:34 (KJV).
Comroe JH:  Retrospectroscope . Am Rev Respir Dis 119:308-808, 1979;.
Elam JO, Brown ES, Elder JD:  Artificial respiration by mouth-to-mask method . N Engl J Med 250:749-754, 1954;.
Kouwenhoven WB, Jude JR, Knickerbocker GG:  Closed-chest cardiac massage . JAMA 173:1064-1067, 1960;.
Jude JR, Kouwenhoven WB, Knickerbocker GG:  Cardiac arrest: Report of application of external cardiac massage on 118 patients . JAMA 178:1063-1070, 1961;.
Weale FE, Rothwell-Jackson RL:  The efficiency of cardiac massage . Lancet 1:990-992, 1962;.
MacKenzie GJ, Taylor SH, McDonald AH, et al:  Haemodynamic effects of external cardiac compression . Lancet 1:1342-1345, 1964;.
 Standards for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC), American Heart Association . JAMA 227( (suppl) ):833-868, 1974;.
Taylor GJ, Rubin R, Tucker M, et al:  External cardiac compression: A randomized comparison of mechanical and manual techniques . JAMA 240:644-646, 1978;.
Taylor GJ, Tucker WM, Greene HL, et al:  Importance of prolonged compression during cardiopulmonary resuscitation in man . N Engl J Med 296:1515-1517, 1977;.
Chandra N, Rudikoff M, Tsitlik J, et al:  Augmentation of carotid flow during cardiopulmonary resuscitation (CPR) in the dog by simultaneous compression and ventilation with high airway pressure , abstracted. Am J Cardiol 43:422, 1979;.
Chandra N, Rudikoff M, Weisfeldt ML:  Simultaneous chest compression and ventilation at high airway pressure during cardiopulmonary resuscitation . Lancet 1:175-178, 1980;.
Rudikoff MT, Maughan WL, Effron M, et al:  Mechanisms of blood flow during cardiopulmonary resuscitation . Circulation 61:345-352, 1980;.
Yin CP, Cohen JM, Tsitlik J, et al:  Arterial resistance to collapse: A determinant of peripheral flow resulting from high intrathoracic pressure , abstracted. Circulation 60( (suppl 2) ):196, 1979;.
Cohen JM, Anderson PO, Van Aswegen A, et al:  Timing of intrathoracic blood flow during resuscitation with high intrathoracic pressure , abstracted. Circulation 60( (suppl 2) ):196, 1979;.
Niemann JT, Garner D, Rosborough J, et al:  The mechanism of blood flow in closed chest cardiopulmonary resuscitation , abstracted. Circulation 60( (suppl 2) ):74, 1979;.
Sones FM:  Cine coronary angiography , in Hurst JW, Logue RB (eds): The Heart . New York, McGraw-Hill Book Co Inc, 1970;, pp 377-385.
Criley JM, Blaufuss AH, Kissel GL:  Cough-induced cardiac compression: Self-administered form of cardiopulmonary resuscitation . JAMA 236:1246-1250, 1976;.
Rossen R, Kabat H, Anderson JP:  Acute arrest of cerebral circulation in man . Arch Neurol Psychiat 50:510-528, 1943;.
Cary JM, Ross BK, Krugmire R, et al:  Coughing causes systemic blood flow , abstracted. Chest 74:332-333, 1978;.
Rosborough JP, Hausknecht M, Criley JM, et al:  Cardiac output during ventricular fibrillation in the coughing dog , abstracted. Presented at the American College of Cardiology meetings, March 9-13, 1980 .
Rabson J, Goldberg H, Bromberger-Barnea B, et al:  The use of a pneumatic vest to generate carotid flow in a canine model of circulatory arrest , abstracted. Circulation 60( (suppl 2) ):196, 1979;.
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