Hemodynamic effects of continuous abdominal binding during cardiac arrest and resuscitation

Abstract

Abdominal binding improves arterial pressure and flow during cardiopulmonary resuscitation (CPR). This study was undertaken to assess the mechanisms of improved hemodynamics during cardiac arrest and CPR with continuous abdominal binding in a canine model (n = 8). Carotid and inferior vena caval (IVC) flow probes and cineangiography were used to observe magnitude and direction of blood flow. CPR with binding significantly increased (p less than 0.001) systolic aortic (Ao) (49 +/- 11 vs 34 +/- 12 mm Hg), right atrial (RA) (49 +/- 11 vs 31 +/- 10 mm Hg) and IVC pressure (50 +/- 7 versus 31 +/- 11 mm Hg) and common carotid flow (1.1 +/- 0.4 vs 0.7 +/- 0.4 ml/min/kg, p less than 0.05) compared with CPR without binding. Aortic, RA and IVC diastolic pressures increased similarly. Binding decreased the diastolic Ao-IVC pressure difference by 8 +/- 12 mm Hg and decreased net IVC flow (0.5 +/- 1.4 vs 1.4 +/- 1.2 ml/min/kg, p less than 0.05). Binding also decreased coronary perfusion pressure (Ao-RA) in 5 of 8 dogs. Cineangiograms showed tricuspid incompetence and reflux from the right atrium to the inferior vena cava during chest compression and IVC-to-right heart inflow during relaxation, which was confirmed by the flowmeter data. Abdominal binding during CPR decreased the size of the perfused vascular bed by inhibiting subdiaphragmatic flow and increased intrathoracic pressure for a given chest compression force, leading to preferential cephalad flow. However, coronary perfusion pressure was often adversely affected. Further studies should be undertaken before the widespread clinical application of continuous abdominal binding during CPR.