Direction of blood flow from the left ventricle during cardiopulmonary resuscitation in humans-its implications for mechanism of blood flow

Hyun Kim, Sung Oh Hwang, Christopher C. Lee, Kang Hyun Lee, Jang Young Kim, Byungsu Yoo, Seunghwan Lee, Junghan Yoon, Kyung Hoon Choe, Adam J. Singer

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Common mechanisms proposed to explain forward blood flow during cardiopulmonary resuscitation (CPR) include the cardiac and thoracic pumps. However, the exact role of the left ventricle in promoting forward blood flow during standard CPR in humans is mostly unknown. The aim of this study was to explore the role of the left ventricle in generating forward blood flow during standard CPR in humans by observing the direction of blood flow during CPR. Methods: Ten patients with non-traumatic cardiac arrest were enrolled in this study. During CPR, contrast echocardiography with agitated saline was performed in the left ventricle and the aorta, and the direction of contrast flow was assessed using transesophageal echocardiography. Results: On injecting the contrast in the aortic root, anterograde flow from the aorta during the compression phase was observed. No aortic regurgitation was present. Retrograde blood flow from the left ventricle into the left atrium as well as anterograde blood flow from the left ventricle into the aorta during the compression phase of CPR was observed in all cases. On injecting the contrast in the aortic root, anterograde flow from the aorta during the compression phase was observed. During each cycle of chest compression, the mitral valve closed during compression and opened during relaxation, and the aortic valve opened during compression and closed during relaxation. Conclusions: Retrograde flow to the left atrium and forward blood flow onto the aorta on left ventricular contrast echocardiography during the compression phase suggests that extrinsic compression of the left ventricle by external chest compression acts as a pump in generating blood flow during standard CPR in humans.

Original languageEnglish
Pages (from-to)1222.e1-1222.e7
JournalAmerican Heart Journal
Volume156
Issue number6
DOIs
Publication statusPublished - 2008 Jan 1

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Cardiopulmonary Resuscitation
Heart Ventricles
Aorta
Thorax
Heart Atria
Echocardiography
Aortic Valve Insufficiency
Direction compound
Transesophageal Echocardiography
Heart Arrest
Aortic Valve
Mitral Valve

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kim, Hyun ; Hwang, Sung Oh ; Lee, Christopher C. ; Lee, Kang Hyun ; Kim, Jang Young ; Yoo, Byungsu ; Lee, Seunghwan ; Yoon, Junghan ; Choe, Kyung Hoon ; Singer, Adam J. / Direction of blood flow from the left ventricle during cardiopulmonary resuscitation in humans-its implications for mechanism of blood flow. In: American Heart Journal. 2008 ; Vol. 156, No. 6. pp. 1222.e1-1222.e7.
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abstract = "Background: Common mechanisms proposed to explain forward blood flow during cardiopulmonary resuscitation (CPR) include the cardiac and thoracic pumps. However, the exact role of the left ventricle in promoting forward blood flow during standard CPR in humans is mostly unknown. The aim of this study was to explore the role of the left ventricle in generating forward blood flow during standard CPR in humans by observing the direction of blood flow during CPR. Methods: Ten patients with non-traumatic cardiac arrest were enrolled in this study. During CPR, contrast echocardiography with agitated saline was performed in the left ventricle and the aorta, and the direction of contrast flow was assessed using transesophageal echocardiography. Results: On injecting the contrast in the aortic root, anterograde flow from the aorta during the compression phase was observed. No aortic regurgitation was present. Retrograde blood flow from the left ventricle into the left atrium as well as anterograde blood flow from the left ventricle into the aorta during the compression phase of CPR was observed in all cases. On injecting the contrast in the aortic root, anterograde flow from the aorta during the compression phase was observed. During each cycle of chest compression, the mitral valve closed during compression and opened during relaxation, and the aortic valve opened during compression and closed during relaxation. Conclusions: Retrograde flow to the left atrium and forward blood flow onto the aorta on left ventricular contrast echocardiography during the compression phase suggests that extrinsic compression of the left ventricle by external chest compression acts as a pump in generating blood flow during standard CPR in humans.",
author = "Hyun Kim and Hwang, {Sung Oh} and Lee, {Christopher C.} and Lee, {Kang Hyun} and Kim, {Jang Young} and Byungsu Yoo and Seunghwan Lee and Junghan Yoon and Choe, {Kyung Hoon} and Singer, {Adam J.}",
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Direction of blood flow from the left ventricle during cardiopulmonary resuscitation in humans-its implications for mechanism of blood flow. / Kim, Hyun; Hwang, Sung Oh; Lee, Christopher C.; Lee, Kang Hyun; Kim, Jang Young; Yoo, Byungsu; Lee, Seunghwan; Yoon, Junghan; Choe, Kyung Hoon; Singer, Adam J.

In: American Heart Journal, Vol. 156, No. 6, 01.01.2008, p. 1222.e1-1222.e7.

Research output: Contribution to journalArticle

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T1 - Direction of blood flow from the left ventricle during cardiopulmonary resuscitation in humans-its implications for mechanism of blood flow

AU - Kim, Hyun

AU - Hwang, Sung Oh

AU - Lee, Christopher C.

AU - Lee, Kang Hyun

AU - Kim, Jang Young

AU - Yoo, Byungsu

AU - Lee, Seunghwan

AU - Yoon, Junghan

AU - Choe, Kyung Hoon

AU - Singer, Adam J.

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N2 - Background: Common mechanisms proposed to explain forward blood flow during cardiopulmonary resuscitation (CPR) include the cardiac and thoracic pumps. However, the exact role of the left ventricle in promoting forward blood flow during standard CPR in humans is mostly unknown. The aim of this study was to explore the role of the left ventricle in generating forward blood flow during standard CPR in humans by observing the direction of blood flow during CPR. Methods: Ten patients with non-traumatic cardiac arrest were enrolled in this study. During CPR, contrast echocardiography with agitated saline was performed in the left ventricle and the aorta, and the direction of contrast flow was assessed using transesophageal echocardiography. Results: On injecting the contrast in the aortic root, anterograde flow from the aorta during the compression phase was observed. No aortic regurgitation was present. Retrograde blood flow from the left ventricle into the left atrium as well as anterograde blood flow from the left ventricle into the aorta during the compression phase of CPR was observed in all cases. On injecting the contrast in the aortic root, anterograde flow from the aorta during the compression phase was observed. During each cycle of chest compression, the mitral valve closed during compression and opened during relaxation, and the aortic valve opened during compression and closed during relaxation. Conclusions: Retrograde flow to the left atrium and forward blood flow onto the aorta on left ventricular contrast echocardiography during the compression phase suggests that extrinsic compression of the left ventricle by external chest compression acts as a pump in generating blood flow during standard CPR in humans.

AB - Background: Common mechanisms proposed to explain forward blood flow during cardiopulmonary resuscitation (CPR) include the cardiac and thoracic pumps. However, the exact role of the left ventricle in promoting forward blood flow during standard CPR in humans is mostly unknown. The aim of this study was to explore the role of the left ventricle in generating forward blood flow during standard CPR in humans by observing the direction of blood flow during CPR. Methods: Ten patients with non-traumatic cardiac arrest were enrolled in this study. During CPR, contrast echocardiography with agitated saline was performed in the left ventricle and the aorta, and the direction of contrast flow was assessed using transesophageal echocardiography. Results: On injecting the contrast in the aortic root, anterograde flow from the aorta during the compression phase was observed. No aortic regurgitation was present. Retrograde blood flow from the left ventricle into the left atrium as well as anterograde blood flow from the left ventricle into the aorta during the compression phase of CPR was observed in all cases. On injecting the contrast in the aortic root, anterograde flow from the aorta during the compression phase was observed. During each cycle of chest compression, the mitral valve closed during compression and opened during relaxation, and the aortic valve opened during compression and closed during relaxation. Conclusions: Retrograde flow to the left atrium and forward blood flow onto the aorta on left ventricular contrast echocardiography during the compression phase suggests that extrinsic compression of the left ventricle by external chest compression acts as a pump in generating blood flow during standard CPR in humans.

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