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J Korean Soc Emerg Med > Volume 14(2); 2003 > Article
Journal of The Korean Society of Emergency Medicine 2003;14(2): 178-184.
Mitral Regurgitation on Left Ventricular Contrast Echocardiography during Cardiopulmonary Resuscitation in Humans: Its Implications for the Mechanism of Forward Blood Flow
Sung Oh Hwang, Seo Young Lee, Hyun Kim, Kang Hyun Lee, Yong Soo Jang, Han Joo Choi, Byung Su Yoo, Seung Hwan Lee, Junghan Yoon, Kyung Hoon Choe, Jun Hwi Cho
1Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea. cshwang@wonju.yonsei.ac.kr
2Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
3Department of Emergency Medicine, Kangwon University, Chooncheon, Korea.
4Department of Kangwon College of Medicine, Kangwon University, Chooncheon, Korea.
ABSTRACT
PURPOSE:
In the mechanism of forward blood flow during cardiopulmonary resuscitation (CPR) in humans, the role of the left ventricle remains to be investigated. The aim of this study was to assess the role of the left ventricle in generating forward blood flow in humans during CPR by performing contrast echocardiography.
METHODS:
Ten patients with non-traumatic cardiac arrest were enrolled. During CPR, a pigtail catheter was introduced to the left ventricle and a central venous catheter was introduced to the right atrium under transesophageal echocardiographic guidance. Ten (10) ml of agitated saline was injected into the left ventricle to perform contrast echocardiography during CPR. The direction of contrast flow and the presence of mitral regurgitation were assessed with a 135 degree longitudinal view. Pressures were traced in the left ventricle, the aorta, and the right atrium.
RESULTS:
Forward flow toward the aorta and mitral regurgitation (MR) were visualized during compression systole on left ventricular contrast echocardiography in all patients: grade I in 1, grade II in 3, grade III in 4, and grade IV in 2 patients. There was no differences in the clearing times (29+/-24 vs 22+/-12 sec) or the numbers of chest compressions (53+/-32 vs 48+/-28) of the contrast from the left ventricle, the systolic left ventricular pressures (96+/-13 mmHg vs 126+/-48 mmHg), the systolic aortic pressures (90+/-11 mmHg vs 116+/-58 mmHg), the diastolic aortic pressures (33+/-13 mmHg vs 32+/-9 mmHg), the coronary perfusion pressures (23+/-12 mmHg vs 26+/-8 mmHg), and the end tidal carbon dioxide tensions (13+/-12 mmHg vs 9+/-3 mmHg) between the mild MR group (MR grades I and II) and the severe MR group (MR grades III and IV). The left ventricular ejection fraction was higher in the severe MR group than in the mild MR group.
CONCLUSION:
Mitral regurgitation on left ventricular contrast echocardiography during compression systole suggests that cardiac pumping is the dominant mechanism in generating forward blood flow during standard CPR in humans.
Key words: Cardiopulmonary resuscitation, Cardiac arrest
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