Computational simulation of passive leg-raising effects on hemodynamics during cardiopulmonary resuscitation. (March 2017) - Shin, Dong Ah
Highlights: A computational model was used to simulate the passive leg raising (PLR) maneuver during cardiopulmonary resuscitation (CPR). Cardiac output (CO), coronary perfusion pressure (CPP), and systematic perfusion pressure (SPP), were compared between PLR-CPR and CPR only. Hemodynamic effects improve during PLR-CPR compared to CPR only. An optimal angle for the PLR maneuver delivers the optimum hemodynamic effects. Abstract: Background and objective: The passive leg-raising (PLR) maneuver has been used for patients with circulatory failure to improve hemodynamic responsiveness by increasing cardiac output, which should also be beneficial and may exert synergetic effects during cardiopulmonary resuscitation (CPR). However, the impact of the PLR maneuver on CPR remains unclear due to difficulties in monitoring cardiac output in real-time during CPR and a lack of clinical evidence. Methods: We developed a computational model that couples hemodynamic behavior during standard CPR and the PLR maneuver, and simulated the model by applying different angles of leg raising from 0° to 90° and compression rates from 80/min to 160/min. Results: The simulation results showed that the PLR maneuver during CPR significantly improves cardiac output (CO), systemic perfusion pressure (SPP) and coronary perfusion pressure (CPP) by ∼40–65% particularly under the recommended range of compression rates between 100/min and 120/min with 45° of leg raise, compared to standard CPR. However, such effects start to wane with further leg lifts, indicating the existence of an optimal angle of leg raise for each person to achieve the best hemodynamic responses. Conclusions: We developed a CPR-PLR model and demonstrated the effects of PLR on hemodynamics by investigating changes in CO, SPP, and CPP under different compression rates and angles of leg raising. Our computational model will facilitate study of PLR effects during CPR and the development of an advanced model combined with circulatory disorders, which will be a valuable asset for further studies.