Phased chest and abdominal compression-decompression is the newest alternative to conventional precordial compression. Experimental outcomes have only recently been reported (Tang e.L§L 1997). This technique provides for reciprocal compression and decompression of the chest and abdomen with a Lifestick ™
resuscitator (Fig 4) which resembles a manual seesaw. The precordium and abdomen are compressed at a rate of 60/min with compression forces of 120 lb (55 kg)
and 50 lb (23 kg) respectively. The reciprocal seesaw operation involves a specified phase delay. This technique combines the advantage of active chest compression-decompression and interposed abdominal compression. Abdominal decompression serves to reduce both left and right ventricular afterloads with consequent increases in stroke volumes.
Fig. 2 Vest cardiopulmonary resuscitation.
Fig. 3 Active compression-decompression.
This technique has demonstrated impressive hemodynamic efficacy in animal studies. The coronary perfusion pressure generated was three times greater than that generated by conventional precordial compression. This was associated with a striking improvement in initial resuscitability and 72-h survival. Experimental studies have shown a significantly lower incidence of rib fractures and injuries to the thoracic or abdominal organs; human evaluation is ongoing. Hemodynamic efficacy has also been claimed in preliminary human trials.
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