Original Articles Korean Circulation J 1999;29 10 : 심정지동물모델에서이중혈류유발심폐소생술과 표준심폐소생술의혈역학적효과비교 황성오 1 조준휘 1 오범진 1 강구현 1 김성환 1 문중범 1 이서영 1 박해상 1 이강

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1 Original Articles Korean Circulation J 1999;2910: 심정지동물모델에서이중혈류유발심폐소생술과 표준심폐소생술의혈역학적효과비교 황성오 1 조준휘 1 오범진 1 강구현 1 김성환 1 문중범 1 이서영 1 박해상 1 이강현 1 이승환 2 윤정한 2 최경훈 2 이윤선 3 Hemodynamic Effects of Simultaneous Sterno-Thoracic Cardiopulmonary ResuscitationSST-CPR in Canine Model of Cardiac Arrest Sung Oh Hwang, MD 1, Jun Hwi Cho, MD 1, Bum Jin Oh, MD 1, Ku Hyun Kang, MD 1, Sung Hwan Kim, MD 1, Joong Bum Moon, MD 1, Seo Young Lee, MD 1, Hae Sang Park, MD 1, Kang Hyun Lee, MD 1, Seung Hwan Lee, MD 2, Junghan Yoon, MD 2, Kyung Hoon Choe, MD 2 and Yoon Sun Lee, MD 3 1 Department of Emergency Medicine and 2 Internal Medicine, Wonju College of Medicine and 3 Department of Biomedical Electronic Engineering, College of Health Science, Yonsei University, Wonju, Korea ABSTRACT Background and ObjectivesNo existing device for cardiopulmonary resuscitation CPR is designed to exploit both the cardiac pumpand the thoracic pumpsimultaneously. This study was designed to assess the hemodynamic effects of simultaneous sterno-thoracic CPR SST-CPR vs. standard CPR S-CPR using a mechanical resuscitator in a canine model of cardiac arrest. Device DescriptionWe have built a device that depresses the sternum and circumferentially constricts the thorax simultaneously. This device has two components. The first component is a piston, which depresses the sternum. The second is a circumferential strap that constricts the thorax as the piston is pushed down on the sternum. Materials and MethodsTwelve domestic dogs were enrolled in this study. After catheterizations to measure pressures from the aorta and the right atrium, ventricular fibrillation was induced by passing AC current to the right ventricle. After 4 minutes of cardiac arrest, S-CPR and SST-CPR were performed alternatively. Aortic pressure, right atrial pressure, cardiac output, and end tidal CO 2 were measured while each method of CPR was performing. ResultsSST-CPR resulted in significantly higher mean arterial pressure than S-CPR vs mmhg, p0.01. SST-CPR could generate higher coronary perfusion pressure than S-CPR vs mmhg, p0.01. End tidal CO 2 tension was also higher during SST-CPR than S-CPR vs mmhg, p0.01. ConclusionSimultaneous sternothoracic cardiopulmonary resuscitation is a new method of cardiopulmonary resuscitation, which can generate better hemodynamic effects than standard cardiopulmonary resuscitation. Korean Circulation J 1999;2910: KEY WORDSCardiopulmonary resuscitation Cardiac arrest. 1105

Simultaneous sternothoracic cardiopulmonary resuscitation SST-CPRDuring compression systole, the strap constricts the thorax

During compression diastole, the piston returns to it s original position by recoiling force of the thorax of itself. Fig. 2.

2 서론 대상및방법 이중혈류유발심폐소생술장치 1106 Fig. 1. Simultaneous sternothoracic cardiopulmonary resuscitation SST-CPRDuring compression systole, the strap constricts the thorax while the piston depresses the sternum. During compression diastole, the piston returns to it s original position by recoiling force of the thorax of itself. Fig. 2. Top view upperand side view lower of the device for simultaneous sternothoracic cardiopulmonary resuscitationthe device consists of two main elements. Piston A in the center is to depress the sternum. Strap B is to constrict the thorax circumferentially. Strap is attached to both sides of the piston. When the piston is pushed down, it depresses the sternum and pulls on the thoracic strap. 동물실험 Korean Circulation J 1999;2910:

3 1107

4 Fig. 3. Experimental protocol. *Epiepinephrine injection, S-CPRstandard cardiopulmonary resuscitation, SST-CPRsimultaneous sternothoracic cardiopulmonary resuscitation. 결 과 Fig. 4. Aortic pressure wave from standard cardiopulmonary resuscitation S-CPR and simultaneous sternothoracic cardiopulmonary resuscitation SST-CPR SST-CPR generated higher aortic pressure as well as a distinct pressure wave form with two peaks during the systole. Fig. 5. Aortic pressures from standard cardiopulmonary resu-scitation S-CPR and simultaneous sternothoracic cardiopulmonary resuscitation SST-CPR.*p0.01, compared with S-CPR 1108 Korean Circulation J 1999;2910:

5 Fig. 6. Coronary Perfusion PressureSimultaneous sternothoracic cardiopulmonary resuscitation SST-CPR could gene-rate higher coronary perfusion pressure than standard CPR S-CPR. *p0.01, compared with S-CPR Fig. 7. End-tidal CO2Higher end tidal CO2 value was observed during simultaneous sternothoracic cardiopulmonary resuscitation SST-CPR. *p0.01, compared with S-CPR 고 이중혈류유발심폐소생술의혈류유발기전 찰 이중혈류유발심폐소생술에의한관상동맥관류압과호기말이산화탄소압 1109

6 새로운심폐소생술방법으로서의이중혈류유발심폐소생술 1110 연구의제한점 Korean Circulation J 1999;2910:

7 결 중심단어 론 REFERENCES 1) Paradis NA, Martin GB, Rivers EP, Goetting MG, Appleton TJ, Feingold M, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA ) Sanders AB, Ogle M, Ewy GA. Coronary perfusion pressure during cardiopulmonary resuscitation. Am J Emerg Med ) Fitzgerald KR, Babbs CF, Frissora HA, Davis RW, Silver DI. Cardiac output during cardiopulmonary resuscitation at various compression rates and durations. Am J Physiol1981. p.h ) Voorhees WD, Babbs CF, Tacker WA Jr. Regional blood flow during cardiopulmonary resuscitation in dogs. Crit Care Med ) Wolfe JA, Maier GW, Newton JR Jr, Glower DD, Tyson GS Jr, Spratt JA, et al. Physiologic determinants of coronary blood flow during external cardiac massage. J Thorac Cardiovasc Surg ) Higano ST, Oh JK, Ewy GA. The mechanism of blood flow during closed chest cardiac massage in humans: Transesophag-eal echocardiographic observations. Mayo Clin Proc 1990;65: ) Feneley MP, Maier GW, Gaynor JW, Gall SA, Kisslo JA, Davis JW, et al. Sequence of mitral valve motion and transmitral blood flow during manual cardiopulmonary resuscitation in dogs. Circulation ) Criley JM, Blaufuss AN, Kissel GL. Cough induced cardiac compression. JAMA ) Niemann JT, Rosborough JP, Hausknecht M, Garner D, Criley JM. Pressure-synchronized cineangiography during experimental cardiopulmonary resuscitation. Circulation ) Halperin HR, Tsitlik JE, Guerci AD, Mellits ED, Levin HR, Shi AY, et al. Determinants of blood flow to vital organs during cardiopulmonary resuscitation in dogs. Circulation ) Guideline for cardiopulmonary resuscitation and emergency cardiac care. Recommendation of the 1992 National Conference, Emergency Cardiac Care Committee and Subcommittees, American Heart Association. JAMA ) Hwang SO, Choe KH, Lee KH, Lee JW, Lee SH, Yoon J. Changes of aortic dimensions as an evidence of cardiac pump mechanism during cardiopulmonary resuscitation: Transesophageal echocardiographic observation. J Am Coll Cardiol C. 13) Ma MH, Hwang JJ, Lai LP, Wang SM, Huang GT, Shyu KG, et al. Transesophageal echocardiographic assessment of mitral valve position and pulmonary venous flow during cardiopulmonary resuscitation in humans. Circulation ) Gudipati CV, Weil MH, Bisera J, Deshmukh HG, Rackow EC. Expired carbon dioxide A noninvasive monitor of cardiopul-monary resuscitation. Circulation ) Weil MH, Bisera J, Trevino RP, Rackow EC. Cardiac output and end-tidal carbon dioxide Crit Care Med ) Ornato JP, Garnett AR, Glauser FL. Relationship between cardiac output and the end-tidal carbon dioxide tension. Ann Emerg Med ) Levine RL, Wayne MA, Miller CC. End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med ) Chandra N, Rudikoff M, Weisfeldt ML. Simultaneous chest compression and ventilation at high airway pressure during cardiopulmonary resuscitation. Lancet ) Babbs CF, Tacker WA Jr. Cardiopulmonary resuscitation with interposed abdominal compression. Circulation IV ) Maier GW, Newton JR Jr, Wolfe JA, Tyson GS Jr, Olsen CO, Glower DD, et al. The influence of manual chest compression rate on hemodynamic support during cardiac arrest High-impulse cardiopulmonary resuscitation. Circulation IV ) Lindner KH, Pfenninger EG, Lurie KG, Schurmann W, Lindner IM, Ahnefeld FW. Effects of active compressiondecompression resuscitation on myocardial and cerebral blood flow in pigs. Circulation ) Tang W, Weil MH, Schock RB, Sato Y, Lucas J, Sun S, et al. Phased chest and abdominal compression-decompression. A new option for cardiopulmonary resuscitation. Circulation ) Halperin HR, TsitlikJE, Gelfand M, Weisfeldt ML, Gruben KG, Levin HR. A preliminary study of cardiopulmonary resuscitation by circumferential compression of the chest with use of a pneumatic vest. N Eng J Med

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386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon