Transesophageal echocardiographic assessment of mitral valve position and pulmonary venous flow during cardiopulmonary resuscitation in humans

Matthew Huei Ming Ma, Juey Jen Hwang, Ling Ping Lai, Shih Ming Wang, Guan Tarn Huang, Kou Gi Shyu, Yu Lin Ko, Jiunn Lee Lin, Wen Jone Chen, Kwan Lih Hsu, Jin Jer Chen, Peiliang Kuan, Yung Zu Tseng, Wen Pin Lien

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background: The mechanisms of blood flow during closed-chest cardiopulmonary resuscitation (CPR) in humans have been debated since the technique was first described in 1960. Two competing models, the cardiac pump theory and the thoracic pump theory, have been proposed, and some investigators have used mitral valve position during the downstroke of chest compression to distinguish between them. Previous studies using either transthoracic or transesophageal echocardiography have yielded conflicting results, and there have been few, if any, hemodynamic or echocardiographic studies on pulmonary venous flow (PVF) during CPR. Methods and Results: In this study, transesophageal two-dimensional and pulsed Doppler echocardiography were used to study mitral valve position and flow, together with PVF, in 20 adult patients undergoing manual CPR. In the 17 patients who could be analyzed, the mitral valve closed in 5 patients (group 1) during chest compression but stayed open or opened further in the remaining 12 patients (group 2). Peak forward mitral flow occurred during the release phase in group 1 but during the compression phase in group 2. During chest compression, PVF occurred in the forward direction (from the pulmonary vein to the left atrium) in 8 of the group 2 patients (group 2a) and in the backward direction (from the left atrium to the pulmonary vein) in all group 1 patients and the remaining 4 patients in group 2 (group 2b). The downtime (time from collapse to CPR) was significantly shorter (P<.05) for those in group 1 (7.0±4.4 minutes) than in groups 2a (19.8±7.7 minutes) and 2b (17.8±6.8 minutes). Conclusions: Transesophageal echocardiography performed during manual CPR in humans disclosed three different patterns of mitral valve position and PVF during chest compression. The presence of an opened mitral valve with forward mitral flow and backward pulmonary venous flow during chest compression in a small number of subjects underscores this heterogeneity in blood flow and suggests the possible existence of a 'left atrium pump' in addition to the currently known 'left ventricle pump' and 'chest pump' mechanisms.

Original languageEnglish
Pages (from-to)854-861
Number of pages8
JournalCirculation
Volume92
Issue number4
DOIs
Publication statusPublished - Aug 15 1995
Externally publishedYes

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Cardiopulmonary Resuscitation
Mitral Valve
Thorax
Lung
Heart Atria
Pulmonary Veins
Transesophageal Echocardiography
Doppler Echocardiography
Heart Ventricles
Echocardiography
Hemodynamics
Research Personnel

Keywords

  • blood flow
  • cardiac arrest
  • cardiopulmonary resuscitation
  • echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Transesophageal echocardiographic assessment of mitral valve position and pulmonary venous flow during cardiopulmonary resuscitation in humans. / Ma, Matthew Huei Ming; Hwang, Juey Jen; Lai, Ling Ping; Wang, Shih Ming; Huang, Guan Tarn; Shyu, Kou Gi; Ko, Yu Lin; Lin, Jiunn Lee; Chen, Wen Jone; Hsu, Kwan Lih; Chen, Jin Jer; Kuan, Peiliang; Tseng, Yung Zu; Lien, Wen Pin.

In: Circulation, Vol. 92, No. 4, 15.08.1995, p. 854-861.

Research output: Contribution to journalArticle

Ma, MHM, Hwang, JJ, Lai, LP, Wang, SM, Huang, GT, Shyu, KG, Ko, YL, Lin, JL, Chen, WJ, Hsu, KL, Chen, JJ, Kuan, P, Tseng, YZ & Lien, WP 1995, 'Transesophageal echocardiographic assessment of mitral valve position and pulmonary venous flow during cardiopulmonary resuscitation in humans', Circulation, vol. 92, no. 4, pp. 854-861. https://doi.org/10.1161/01.CIR.92.4.854
Ma, Matthew Huei Ming ; Hwang, Juey Jen ; Lai, Ling Ping ; Wang, Shih Ming ; Huang, Guan Tarn ; Shyu, Kou Gi ; Ko, Yu Lin ; Lin, Jiunn Lee ; Chen, Wen Jone ; Hsu, Kwan Lih ; Chen, Jin Jer ; Kuan, Peiliang ; Tseng, Yung Zu ; Lien, Wen Pin. / Transesophageal echocardiographic assessment of mitral valve position and pulmonary venous flow during cardiopulmonary resuscitation in humans. In: Circulation. 1995 ; Vol. 92, No. 4. pp. 854-861.
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T1 - Transesophageal echocardiographic assessment of mitral valve position and pulmonary venous flow during cardiopulmonary resuscitation in humans

AU - Ma, Matthew Huei Ming

AU - Hwang, Juey Jen

AU - Lai, Ling Ping

AU - Wang, Shih Ming

AU - Huang, Guan Tarn

AU - Shyu, Kou Gi

AU - Ko, Yu Lin

AU - Lin, Jiunn Lee

AU - Chen, Wen Jone

AU - Hsu, Kwan Lih

AU - Chen, Jin Jer

AU - Kuan, Peiliang

AU - Tseng, Yung Zu

AU - Lien, Wen Pin

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N2 - Background: The mechanisms of blood flow during closed-chest cardiopulmonary resuscitation (CPR) in humans have been debated since the technique was first described in 1960. Two competing models, the cardiac pump theory and the thoracic pump theory, have been proposed, and some investigators have used mitral valve position during the downstroke of chest compression to distinguish between them. Previous studies using either transthoracic or transesophageal echocardiography have yielded conflicting results, and there have been few, if any, hemodynamic or echocardiographic studies on pulmonary venous flow (PVF) during CPR. Methods and Results: In this study, transesophageal two-dimensional and pulsed Doppler echocardiography were used to study mitral valve position and flow, together with PVF, in 20 adult patients undergoing manual CPR. In the 17 patients who could be analyzed, the mitral valve closed in 5 patients (group 1) during chest compression but stayed open or opened further in the remaining 12 patients (group 2). Peak forward mitral flow occurred during the release phase in group 1 but during the compression phase in group 2. During chest compression, PVF occurred in the forward direction (from the pulmonary vein to the left atrium) in 8 of the group 2 patients (group 2a) and in the backward direction (from the left atrium to the pulmonary vein) in all group 1 patients and the remaining 4 patients in group 2 (group 2b). The downtime (time from collapse to CPR) was significantly shorter (P<.05) for those in group 1 (7.0±4.4 minutes) than in groups 2a (19.8±7.7 minutes) and 2b (17.8±6.8 minutes). Conclusions: Transesophageal echocardiography performed during manual CPR in humans disclosed three different patterns of mitral valve position and PVF during chest compression. The presence of an opened mitral valve with forward mitral flow and backward pulmonary venous flow during chest compression in a small number of subjects underscores this heterogeneity in blood flow and suggests the possible existence of a 'left atrium pump' in addition to the currently known 'left ventricle pump' and 'chest pump' mechanisms.

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