Resuscitation 81 (2010) 1216
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Resuscitation
journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor
Cardiac output measurement during mechanical CPR in porcine
models
Sir,
Carretaro et al. should be commended for evaluating a poten-
tially new technology for measuring cardiac output noninvasively
in the low-flow state of cardiac arrest.1 As they point out, ther-
modilution is generally not applicable in this setting, and end-tidal
CO2 is an indirect indicator. Their data would seem to demonstrate
that noninvasive partial CO2 reading breathing may be a useful
biomarker of hemodynamics in this setting, if validated by other
investigators.2
We would like, however to suggest that their hemodynamic data
during load distributing band CPR (LDB-CPR) is likely misleading.
The AutoPulse device is optimized for the human chest, and utilizes
an automated algorithm to size the patient and adjust the compres-
sion depth. Porcine models, such as used by Carretaro et al., have
thoracic morphology and size significantly different than humans.
Our experience has been that these differences will result in rela-
tively large decrements in compression depth and hemodynamics
during porcine CPR.
When the human AutoPulse is used in animal models, the angles
and distances between the band, the patient, and the uptake mech-
anism will be incorrect. The optimal configuration of the bladders
within the band itself is also different in pigs and humans. To
appropriately evaluate LDB-CPR in animals, we developed a porcine
specific device.
Piston type CPR devices that can be manually adjusted produce
chest compressions through posterior movement of the sternum in
a single vector and the porcine keel shaped chest is not an impedi-
ment to their efficacy.
Unless a device optimized for the porcine chest is utilized,
the perfusion pressures generated will not be true indicator
of the hemodynamics that can be achieved with LDB-CPR We
have referred to this in earlier publications, in which a custom
device has been used and compression depth confirmed with
cineradiograms.3,4 The hemodynamic performance of LDB-CPR has
been documenting in multiple laboratory and clinical studies.3–5
Its appropriate evaluation in animals does, however, require use of
the correct device.
Carretaro et al. properly focused their analysis on the correlation
of cardiac output measurements under varying conditions, and the
0300-9572/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.resuscitation.2010.04.037
use of a human optimized device in a porcine model in no way
affects this primary analysis. We simply want to emphasize that
the cardiac outputs of the different devices in this porcine should
not be misinterpreted as reflecting their hemodynamics in humans.
Conflict of interest statement
Dr. Halperin is a consultant, and Dr. Paradis an employee of, ZOLL
Circulation, the manufacturer of the AutoPulse device.
References
1. Carretero MJ, Fontanals J, Agusti M, et al. Monitoring in resuscitation: comparison
of cardiac output measurement between pulmonary artery catheter and NICO.
Resuscitation 2010;81:404–9.
2. Osterlund B, Gedeon A, Krill P, Johansson G, Reiz S. A new method of using gas
exchange measurements for the noninvasive determination of cardiac output:
clinical experiences in adults following cardiac surgery. Acta Anaesthesiol Scand
1995;39:727–32.
3. Halperin HR, Paradis N, Ornato JP, et al. Cardiopulmonary resuscitation with a
novel chest compression device in a porcine model of cardiac arrest: improved
hemodynamics and mechanisms. J Am Coll Cardiol 2004;44:2214–20.
4. Ikeno F, Kaneda H, Hongo Y, et al. Augmentation of tissue perfusion by a novel
compression device increases neurologically intact survival in a porcine model of
prolonged cardiac arrest. Resuscitation 2006;68:109–18.
5. Timerman S, Cardoso LF, Ramires JA, Halperin H. Improved hemodynamic per-
formance with a novel chest compression device during treatment of in-hospital
cardiac arrest. Resuscitation 2004;61:273–80.
Henry Halperin
Departments of Medicine, Radiology and Biomedical
Engineering, Johns Hopkins University,
Baltimore, MD, USA
Norman Paradis ∗
Department of Emergency Medicine,
University of Southern California and ZOLL Circulation,
Sunnyvale, CA, USA
∗ Corresponding author. Tel.: +1 858 603 9246;
fax: +1 408 541 1030.
E-mail address:nparadis@zollcirculation.com
(N. Paradis)
22 April 2010