Utilization of a Perfused Cadaveric Cardiac Arrest Model Demonstrates Increased Arterial Blood Pressure With Mechanical CPR Device Compared With Manual CPR

Despite research, quality improvement, and education on cardiac arrest, survival rates remain low. Mechanical CPR (mCPR) devices have been scrutinized, but their performance in certain environments remains unclear. Studies have shown that devices can shift during use, and frequent users may have better outcomes. The challenge is developing a model that accurately represents human anatomy and physiology. Our work explores using new technology to create a cardiac arrest model that explores anatomic and physiologic effects. We hypothesized that a perfused-cadaveric model could establish differences in CPR type and location.

Using MaxFi® Perfused Cadaver technology, four refrigerated cadavers were cannulated for a “beating heart” configuration, continuously filling their hearts with simulated blood. The right carotid artery was cannulated and continuously measured for arterial blood flow. Once carotid arterial blood pressure was confirmed, the pump to the heart was discontinued and placed to a gravity reservoir, providing each cadaver with a continuous arterial blood pressure. Manual and mechanical compressions were obtained at the umbilicus, mid-line mid-sternum, and the Area of Maximal Compression (AMC) on trans-esophageal echocardiography. Manual compressions were hands-only, continuous, and in accordance with the AHA guidelines. Mechanical compressions were conducted with a LUCAS 3 mechanical CPR device. Continuous measurements were taken in each area between compressions, compared to the initial baseline, and the delta systolic arterial blood pressure (deltaSABP) was derived. These measurements were normally distributed and compared using repeated measures ANOVA.

Four cadaveric specimens were compared. Manual CPR at the umbilicus (control), mid-line mid-sternum (MLMS), and TEE-guided areas had a mean deltaSABP of 25.4, 27.7, and 22.8 mmHg, respectively. Mechanical CPR umbilicus (control), MLMS, and TEE-guided areas had a mean deltaSABP of 24.9, 35.5, and 34.4 mmHg, respectively. Mechanical compressions significantly improved mean deltaSABP by 6.3 mmHg (p<0.01), resulting in a relative increase of 24.9% in carotid artery blood pressure when compared to manual compressions.

This study examines a new model for cardiac arrest research. The LUCAS mCPR device generates higher arterial blood pressures than traditional manual CPR in this model.