Sternal Wall Pressure in the Cath Lab
Condition: Perfusion Pressures; Central Venous Pressure; Cardiac Output; CPR; Cardiac Arrest
MeSH terms: Heart Arrest
Study type: Interventional

Summary: 
      This protocol is a prospective interventional pilot study at the Children's Hospital of
      Philadelphia to determine whether or not two increments of sternal pressure known to occur
      during "leaning" in CPR affects hemodynamic function, coronary perfusion pressures, and
      intrathoracic pressure in order to inform the resuscitation community on reasonable target
      pressures to avoid "leaning" on the chest during pediatric CPR.
    

Detailed description: 
      STUDY RATIONALE The critical importance of positive and negative intrathoracic pressures
      during Cardiopulmonary Resuscitation (CPR) has been recently demonstrated. During CPR,
      excessive positive intrathoracic pressure caused by overzealous ventilation or incomplete
      chest wall decompression has a detrimental effect on venous return to the heart, cardiac
      hemodynamics, and survival in adults. FDA-approved monitor/defibrillators with sensors that
      detect and provide feedback on the quality of chest compressions, including the amount of
      sternal pressure ("leaning"), can improve the quality of CPR in adults. These
      monitor/defibrillators have recently been implemented in the PICU and ED at CHOP. However,
      determining whether "leaning" (or gentle sternal pressure) affects return of venous blood to
      the thorax and intrathoracic pressure in children is unknown. A pilot study to determine
      whether or not two increments of sternal pressure known to occur during "leaning" in CPR
      affects hemodynamic function, coronary perfusion pressures, and intrathoracic pressure would
      be a first step toward informing the resuscitation community on reasonable target pressures
      to avoid "leaning" on the chest during pediatric CPR.

      STUDY OBJECTIVE(S)

        -  To characterize the effect of the application of two different weights on the sternum
           known to approximate "leaning" during CPR on central hemodynamic measurements and
           coronary perfusion pressures in mechanically ventilated children.

        -  To characterize the effect of the application of two different weights on the sternum
           known to approximate "leaning" during CPR on intrathoracic pressure in mechanically
           ventilated children STUDY DESIGN This protocol is a prospective interventional pilot
           study at the Children's Hospital of Philadelphia.

      STUDY PHASES Screening: Prospective patients enrolled will be screened by a co-investigator.
      Those that meet inclusion criteria will be approached by a member of the investigative team
      during the routine pre-procedure evaluation in the Cardiac Intake Center for discussion of
      the study and informed consent.

      Phase 1: We will measure the depth of the chest. We will measure central hemodynamic
      pressures and function, coronary perfusion pressures and intrathoracic pressures as two
      weights (10% and 20% of body weight) are placed on the sternum. The primary outcome variable
      will be the change in any of the central hemodynamic measurements before and after each
      weight is applied to the sternum.
    

Intervention name(s): Application of two different sternal weights
Intervention type(s): Other
Intervention description(s): Two separate weights (first 10% of body weight, then 20% of body weight) will be placed on the sternum and changes in central hemodynamic measurements and intrathoracic pressure will be recorded and documented.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Perfusion pressures; central venous pressure; cardiac output; CPR; cardiac arrest; Leaning; incomplete release