Published Online
on September 13, 2008

A more recent version of this article appeared on October 1, 2008

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Original Article

In a Swine Model, Chest Compressions Cause Ventricular Capture, and By Means of a Long-Short Sequence, Ventricular Fibrillation

Jose Osorio¹; Derek J. Dosdall; Robert P. RobichauxJr; Paul B. Tabereaux and Raymond E. Ideker

University of Alabama at Birmingham

¹ E-mail: josorio{at}uab.edu

Background—During resuscitation, fibrillation often recurs. In swine, we studied refibrillation after long duration ventricular fibrillation (LDVF) investigating an association with chest compressions (CCs).

Methods and Results—In Protocol A, 47 episodes of LDVF lasting at least 2.5 min were induced in 8 animals. Following defibrillation, CCs were required for 35 episodes and delivered with a pneumatic device (Lucas-CPR). In 9 episodes, refibrillation occurred within 2 s of CC initiation (Group 1) and in 26 episodes CCs were delivered without refibrillation (Group 2). From the ECG and intracardiac electrodes, the RR interval preceding CCs, the shortest cycle length during the first 2 CCs (Short) and the preceding cycle length (Long) were measured. A similar study was conducted in 3 more animals without intracardiac catheters (Protocol B). In Protocol A, the mean RR before CC was 665±292ms in Group 1 and 769±316 in Group 2. CCs stimulated ventricular beats in all 35 episodes. The Short and Long intervals were shorter in Group 1 (215±31ms and 552±210ms), than in Group 2 (402±153ms and 699±147ms) (p=0.009 and p=0.04, respectively). The Prematurity Index (Short/RR) was lower in Group 1 (0.35±0.09) than Group 2 (0.58±0.21) (p<0.01). A Short interval < 231 ms predicted refibrillation with 88% sensitivity and 91% specificity. In Protocol B, CCs were required in 11 episodes, causing ventricular stimulation in all of them and VF within the first 2 CCs in 3.

Conclusions—Under some conditions, CC during resuscitation can stimulate the ventricles and initiate VF by a long-short sequence.

Key Words: resuscitation • Commotio cordis • chest compression • refibrillation • ventricular capture

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