Physiology of blood flow during cardiopulmonary resuscitation. A transesophageal echocardiographic study.

Abstract

BACKGROUND There are two competing theories of the mechanism of blood flow during cardiopulmonary resuscitation. The "cardiac pump" theory postulates that blood flows because the heart is squeezed between the sternum and the spine. The "thoracic pump" theory postulates that blood flows from the thorax because intrathoracic pressure exceeds extrathoracic vascular pressure and that flow is restricted to the venous-to-arterial direction because of venous valves that prevent retrograde flow at the thoracic inlet. To determine which mechanism is operative during actual cardiopulmonary resuscitation, 20 patients were imaged with transesophageal echocardiography during resuscitation. METHODS AND RESULTS Transesophageal two-dimensional and pulse Doppler echocardiography was begun within 7 minutes of initiation of cardiopulmonary resuscitation. In the 18 patients who could be analyzed, the mitral valve opened during the release phase (diastole) and closed during the compression phase (systole) of cardiopulmonary resuscitation. Mitral velocity-time integral measured 8 +/- 3 cm during diastole. There was compression of right and left ventricular cavities with significant reduction in measured left ventricular volume during cardiopulmonary resuscitation. In five patients, mitral regurgitation was present. CONCLUSIONS Transesophageal echocardiography performed during actual cardiopulmonary resuscitation showing mitral valve opening during cardiac release, reduction of ventricular cavity size with compression, and atrioventricular regurgitation support the cardiac pump theory of cardiopulmonary resuscitation. This study demonstrates the feasibility and usefulness of transesophageal echocardiography during cardiopulmonary resuscitation.