Objectives: The exhaled CO2 signal provides guidance during cardiopulmonary resuscitation. The Airway opening index (AOI) has been recently used to quantify chest-compression (CC) induced expired CO2 oscillations. We aimed to determine whether levels of intrathoracic pressures developed during CC or parameters related to lung structure may affect AOI. Methods: Secondary analysis of a randomized animal study (n = 12) in a porcine model of cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) during ambulance transport. Animals were randomized to 18-min of manual or mechanical CCs. Changes in AOI and right atrial pressure (ΔRAP) were recorded during CCs in animals undergoing manual (n = 6) or mechanical (n = 6) CCs. Lung CT scan and measurement of the respiratory system compliance (Cpl,rs) were performed immediately after return of spontaneous circulation. Results: Animals undergoing mechanical CCs had a lower AOI compared to animals treated with manual CCs (p < 0.001). AOI negatively correlated with the swings of intrathoracic pressure, as measured by the change in ΔRAP (ρ=-0.727, p = 0.007). AOI correlated with the lung density (ρ=-0.818, p = 0.001) and with the Cpl,rs (ρ = 0.676, p = 0.016). Animals with cardiopulmonary resuscitation associated lung edema (CRALE) (i.e. mean CT≥-500 HU) showed lower levels of AOI compared to animals without it (29 ± 12 % versus 50 ± 16 %, p = 0.025). Conclusions: Animals undergoing mechanical CCs had lower levels of AOI compared to animals undergoing manual CCs. A higher swing of intrathoracic pressure during CC, a denser and a stiffer lung were associated with an impaired CO2 exhalation during CC as observed by a lower AOI.

Rezoagli, E., Magliocca, A., Grieco, D., Bellani, G., Ristagno, G. (2022). Impact of lung structure on airway opening index during mechanical versus manual chest compressions in a porcine model of cardiac arrest. RESPIRATORY PHYSIOLOGY & NEUROBIOLOGY, 296(February 2022) [10.1016/j.resp.2021.103807].

Impact of lung structure on airway opening index during mechanical versus manual chest compressions in a porcine model of cardiac arrest

Rezoagli, Emanuele
Primo
;
Magliocca, Aurora
Secondo
;
Bellani, Giacomo
Penultimo
;
2022

Abstract

Objectives: The exhaled CO2 signal provides guidance during cardiopulmonary resuscitation. The Airway opening index (AOI) has been recently used to quantify chest-compression (CC) induced expired CO2 oscillations. We aimed to determine whether levels of intrathoracic pressures developed during CC or parameters related to lung structure may affect AOI. Methods: Secondary analysis of a randomized animal study (n = 12) in a porcine model of cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) during ambulance transport. Animals were randomized to 18-min of manual or mechanical CCs. Changes in AOI and right atrial pressure (ΔRAP) were recorded during CCs in animals undergoing manual (n = 6) or mechanical (n = 6) CCs. Lung CT scan and measurement of the respiratory system compliance (Cpl,rs) were performed immediately after return of spontaneous circulation. Results: Animals undergoing mechanical CCs had a lower AOI compared to animals treated with manual CCs (p < 0.001). AOI negatively correlated with the swings of intrathoracic pressure, as measured by the change in ΔRAP (ρ=-0.727, p = 0.007). AOI correlated with the lung density (ρ=-0.818, p = 0.001) and with the Cpl,rs (ρ = 0.676, p = 0.016). Animals with cardiopulmonary resuscitation associated lung edema (CRALE) (i.e. mean CT≥-500 HU) showed lower levels of AOI compared to animals without it (29 ± 12 % versus 50 ± 16 %, p = 0.025). Conclusions: Animals undergoing mechanical CCs had lower levels of AOI compared to animals undergoing manual CCs. A higher swing of intrathoracic pressure during CC, a denser and a stiffer lung were associated with an impaired CO2 exhalation during CC as observed by a lower AOI.
Articolo in rivista - Articolo scientifico
Airway opening index; Carbon dioxide; Cardiac arrest; Cardiopulmonary resuscitation; Chest compression; Computed tomography; Intrathoracic pressure;
English
29-ott-2021
2022
296
February 2022
103807
none
Rezoagli, E., Magliocca, A., Grieco, D., Bellani, G., Ristagno, G. (2022). Impact of lung structure on airway opening index during mechanical versus manual chest compressions in a porcine model of cardiac arrest. RESPIRATORY PHYSIOLOGY & NEUROBIOLOGY, 296(February 2022) [10.1016/j.resp.2021.103807].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/335891
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