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Sequence of mitral valve motion and transmitral blood flow during manual cardiopulmonary resuscitation in dogs.

Publication ,  Journal Article
Feneley, MP; Maier, GW; Gaynor, JW; Gall, SA; Kisslo, JA; Davis, JW; Rankin, JS
Published in: Circulation
August 1987

According to the thoracic pump model of cardiopulmonary resuscitation (CPR), the heart serves as a passive conduit for blood flow from the pulmonary to the systemic vasculature, necessitating an open mitral valve and anterograde transmitral blood flow during chest compression. To assess the applicability of this model to manual CPR techniques, two-dimensional echocardiograms were recorded from the right chest wall and/or the esophagus in nine dogs (18 to 26 kg) during manual CPR. The aortic valve opened with chest compression and closed with release, while the pulmonary and tricuspid valve leaflets closed with compression and opened during release. The mitral valve remained open during ventilation alone and during abdominal compressions. With the onset of brief, high-velocity (high-impulse) chest compressions, the mitral valve closed rapidly and the left ventricle was deformed, whether compressions were applied to the sternum or the left mid-chest wall. The mitral valve reopened with release of each compression. Left atrial echocardiographic contrast injections confirmed the absence of anterograde transmitral blood flow during high-impulse compression and its presence during release. Failure of mitral leaflet approximation during chest compression was observed only when a very low-velocity, prolonged (low-impulse) compression technique was used, or when regions that did not directly overlie the heart were compressed. Consistent with these observations, simultaneous recordings of the left ventricular and left atrial pressures during high-impulse sternal compressions in five dogs (19 to 25 kg) demonstrated peak and mean left ventriculoatrial pressure gradients of 38.5 +/- 4.0 and 13.5 +/- 2.9 mm Hg, respectively, and these pressure gradients declined with less impulsive compressions. The observations made during all but low-impulse chest compressions are inconsistent with the thoracic pump model, and support direct cardiac compression as the primary mechanism of forward blood flow with more impulsive manual chest compression techniques.

Duke Scholars

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

August 1987

Volume

76

Issue

2

Start / End Page

363 / 375

Location

United States

Related Subject Headings

  • Thorax
  • Resuscitation
  • Pressure
  • Movement
  • Mitral Valve
  • Echocardiography
  • Dogs
  • Cardiovascular System & Hematology
  • Blood Circulation
  • Animals
 

Citation

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Feneley, M. P., Maier, G. W., Gaynor, J. W., Gall, S. A., Kisslo, J. A., Davis, J. W., & Rankin, J. S. (1987). Sequence of mitral valve motion and transmitral blood flow during manual cardiopulmonary resuscitation in dogs. Circulation, 76(2), 363–375. https://doi.org/10.1161/01.cir.76.2.363
Feneley, M. P., G. W. Maier, J. W. Gaynor, S. A. Gall, J. A. Kisslo, J. W. Davis, and J. S. Rankin. “Sequence of mitral valve motion and transmitral blood flow during manual cardiopulmonary resuscitation in dogs.Circulation 76, no. 2 (August 1987): 363–75. https://doi.org/10.1161/01.cir.76.2.363.
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. 1987 Aug;76(2):363–75.
Feneley, M. P., et al. “Sequence of mitral valve motion and transmitral blood flow during manual cardiopulmonary resuscitation in dogs.Circulation, vol. 76, no. 2, Aug. 1987, pp. 363–75. Pubmed, doi:10.1161/01.cir.76.2.363.
Feneley MP, Maier GW, Gaynor JW, Gall SA, Kisslo JA, Davis JW, Rankin JS. Sequence of mitral valve motion and transmitral blood flow during manual cardiopulmonary resuscitation in dogs. Circulation. 1987 Aug;76(2):363–375.

Published In

Circulation

DOI

ISSN

0009-7322

Publication Date

August 1987

Volume

76

Issue

2

Start / End Page

363 / 375

Location

United States

Related Subject Headings

  • Thorax
  • Resuscitation
  • Pressure
  • Movement
  • Mitral Valve
  • Echocardiography
  • Dogs
  • Cardiovascular System & Hematology
  • Blood Circulation
  • Animals