Abdominal counterpulsation in cardiopulmonary resuscitation: Animal models and theoretical considerations

  • Charles F. Babbs
    Address reprint requests to Dr. Babbs: Biomedical Engineering Center, A. A. Potter Building, Room 204, Purdue University, West Lafayette, IN 47907.
    Biomedical Engineering Center, Purdue University, West Lafayette, Indiana, USA.
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      Abdominal counterpulsation improves blood flow during other-wise standard CPR in animal models and in electronic models of the circulation. The method generates both central aortic and central venous pressure pulses. Success depends upon maximizing the former and minimizing the latter. Solution of a simple, first-order, differential equation may provide insight into proper technique. The equation suggests that the central arteriovenous pressure difference is maximized when pressure is applied directly over the abdominal aorta and when fluid loading is avoided. Proper technique may be critical in generating the largest possible arteriovenous pressure difference.


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        • Ohomoto T
        • Miura I
        • Konno S
        A new method of external cardiac massage to improve diastolic augmentation and prolong survival time.
        Ann Thorac Surg. 1976; 21: 284-290
        • Rosborough JP
        • Niemann JT
        • Criley JM
        • et al.
        Lower abdominal compression with synchronized ventilation—A CPR modality.
        Circulation. 1981; 64: 303
        • Criley JM
        • Blaufuss AH
        • Kissel GL
        Cough-induced cardiac compression—A self-administered form of cardiopulmonary resuscitation.
        JAMA. 1976; 236: 1246-1250
        • Ralston SH
        • Babbs CF
        • Niebauer MJ
        Cardiopulmonary resuscitation with interposed abdominal compression in dogs.
        Anesth Analg. 1982; 61: 645-651
        • Birch LH
        • Kenney LJ
        • Doornobs F
        • et al.
        A study of external cardiac compression.
        Mich St Med Soc J. 1962; 61: 1346-1352
        • Geddes LA
        • Babbs CF
        A new technique for the measurement of cardiac output during cardiopulmonary resuscitation.
        Crit Care Med. 1980; 8: 131-133
        • Voorhees WD
        • Babbs CF
        • Niebauer MJ
        Improved oxygen delivery during cardiopulmonary resuscitation with interposed abdominal compressions.
        Ann Emerg Med. 1983; 12: 128-135
        • Coletti RH
        • Kaskel PS
        • Cohen SR
        • et al.
        Abdominal counterpulsation (AC)—A new concept in circulatory assistance.
        Trans Am Soc Artif Intern Organs. 1982; 28: 563-566
        • Coletti RH
        • Kaskel PS
        • Bregman D
        Abdominal counterpulsation (AC)—Effects on canine coronary and carotid blood flow.
        Circulation. 1982; 66: 135
        • Palich WE
        • Gordon AS
        Cardiopulmonary resuscitation of dogs: Principles and practice.
        J Am Vet Med Assoc. 1967; 151: 1719-1732
        • Hoehner PJ
        • Krause GS
        • White BC
        • et al.
        Determination of cerebral cortical blood flow: A thermal technique.
        Ann Emerg Med. 1983; 12: 2-7
        • Voorhees WD
        • Ralston SH
        • Babbs CF
        Regional blood flow during CPR with abdominal counterpulsation in dogs.
        Am J Emerg Med. 1984; 2: 123-128
        • Babbs CF
        • Ralston SH
        • Geddes LA
        Theoretical advantages of abdominal counterpulsation in CPR as demonstrated in a simple electrical model of the circulation.
        Ann Emerg Med. 1983; 13: 660-671
        • Babbs CF
        • Weaver JC
        • Ralston SH
        • et al.
        Cardiac, thoracic, and abdominal pump mechanisms in cardiopulmonary resuscitation: Studies in an electrical model of the circulation.
        Am J Emerg Med. 1984; 2: 299-308
        • Babbs CF
        New versus old theories of blood flow during cardiopulmonary resuscitation.
        Crit Care Med. 1980; 8: 191-195
        • Ralston SH
        • Voorhees WD
        • Babbs CF
        Intrapulmonary epinephrine during cardiopulmonary resuscitation: Improved regional blood flow and resuscitation in dogs.
        Ann Emerg Med. 1984; 13: 79-86
        • Yakaitis RW
        • Ewy GA
        • Otto CW
        • et al.
        Influence of time and therapy on ventricular defibrillation in dogs.
        Crit Care Med. 1980; 8: 157-163
        • Redding JS
        Abdominal compression in cardiopulmonary resuscitation.
        Anesth Analg. 1971; 50: 668-675
      1. Hamilton WF Circulation. Handbook of Physiology. Volume 2. American Physiological Society, Washington, DC1963: 839-864 (section 2)
        • Ditchey RV
        • Lindenfeld J
        Potential adverse effects of volume loading on vital organ perfusion during closed-chest resuscitation.
        Circulation. 1982; 66: 243
        • Voorhees WD
        • Kougias C
        • Schmitz PMW
        • et al.
        Fluid loading with whole blood versus Ringer's solution during CPR in dogs: Effect on oxygen uptake and regional blood flow (abstract).
        Ann Emerg Med. 1984; (in press)
        • Maier GW
        • Tyson GS
        • Kernstine KH
        • et al.
        Coronary blood flow during high impulse external cardiac massage.
        Circulation. 1982; 66: 168