Mecanismo para realizar compressão abdominal
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-Compressão abdominal com dispositivo mecânico para realização das compressões abdominais composto por três componentes: um painel de exibição, alças de aplicação de pressão e um dispositivo de pressão negativa. -Compressão abdominal manual. |
Protocolo 1: RCP com elevação e compressão abdominal |
- Identificação da PCR de acordo com o protocolo da AHA (vítima inconsciente, sem pulso, sem respiração ou respiração em agonia). - Realização de compressões abdominais com dispositivo mecânico. A profundidade, ritmo e frequência das compressões abdominais seguem os mesmos padrões das compressões torácicas indicadas pela AHA(2424 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908...
-2525 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0...
). - Realização de intubação orotraqueal no suporte avançado de vida(2424 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908...
). - A duração da compressão e elevação foi definida em uma proporção de 1:1(2525 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0...
). - A força de compressão aplicada foi de aproximadamente 186 mmHg e a força de elevação foi de aproximadamente 112 mmHg(22 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903...
). - A taxa de compressão e ventilação foi definida como 30:2(2525 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0...
). - Administração de medicamentos de acordo com o protocolo da AHA em vigor na época do estudo(2424 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908...
). |
Protocolo 2: RCP com compressões abdominais e torácicas simultâneas |
-Identificação da PCR conforme protocolo da AHA (vítima irresponsiva, sem pulso, sem respiração ou respiração em gasping). -O protocolo foi iniciado 2 minutos após a cessação da pressão aórtica(1616 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900...
). -Realizado compressões abdominais e torácicas simultâneas(1616 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900...
). -A compressão torácica foi realizada por dispositivo externo com parâmetros da AHA vigente na época. Um manguito de pressão arterial um pouco inflado foi colocado sobre a área mesogástrica. Uma coluna de mercúrio foi fixada ao manguito. As compressões abdominais tinham pressão de 100 mmHg durante a fase de relaxamento do tórax(1616 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900...
). |
Protocolo 3: RCP com compressão abdominal interposta |
- Identificação da PCR conforme o protocolo da AHA (vítima inconsciente, sem pulso, sem respiração ou respiração em agonia)(22 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903...
,1111 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80...
,1313 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900...
14 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80...
-1515 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80...
,1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800...
19 Adams CP, Martin GB, Rivers EP, Ward K, Smithline HA, Rady MY. Hemodynamics of interposed abdominal compression during human cardiopulmonary resuscitation. Acad Emerg Med. 1994;1(5):498-502. https://doi.org/10.1111/j.1553-2712.1994.tb02536.x https://doi.org/10.1111/j.1553-2712.1994...
-2020 Villa GF, Colombo S, Cabrini L, Scandroglio AM, Torri G. Interposed abdominal compression in mechanical cardiopulmonary resuscitation: description of a clinical case. Minerva Anestesiol [Internet]. 1998[cited 2022 Aug 20];64(9):415-8. Available from: https://pubmed.ncbi.nlm.nih.gov/9835731/ https://pubmed.ncbi.nlm.nih.gov/9835731/...
,2222 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255...
-2323 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2...
). - Início da RCP de acordo com o protocolo da AHA vigente na época do estudo(22 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903...
,1111 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80...
,1313 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900...
14 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80...
-1515 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80...
,1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800...
-1919 Adams CP, Martin GB, Rivers EP, Ward K, Smithline HA, Rady MY. Hemodynamics of interposed abdominal compression during human cardiopulmonary resuscitation. Acad Emerg Med. 1994;1(5):498-502. https://doi.org/10.1111/j.1553-2712.1994.tb02536.x https://doi.org/10.1111/j.1553-2712.1994...
,2222 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255...
-2323 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2...
). - Realização de intubação orotraqueal no suporte avançado de vida(1313 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900...
,1515 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80...
,1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
,2323 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2...
). - Realização de desfibrilação em ritmos chocáveis(1313 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900...
). - Realização de compressão abdominal interposta durante a fase de relaxamento da compressão torácica(22 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903...
,1313 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900...
-1414 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80...
,1616 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900...
17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
-1818 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800...
,2323 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2...
-2424 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908...
). - A profundidade, ritmo e frequência das compressões abdominais seguem os ritmos das compressões torácicas indicados pela AHA vigentes na época do estudo(22 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903...
,1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
-1818 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800...
,2222 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255...
-2323 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2...
). - As mãos dos profissionais de saúde foram posicionadas no abdômen da vítima. A base das mãos foi colocada cerca de 3 cm à esquerda da linha média, e os dedos apoiados suavemente no abdômen. Com isso, o abdômen foi comprimido pela região hipotênar e tenar das mãos ao longo de uma linha craniocaudal da aorta abdominal(2222 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255...
). - As compressões abdominais foram realizadas à esquerda da linha média para comprimir preferencialmente a aorta abdominal e minimizar a compressão da veia cava(1515 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80...
,1919 Adams CP, Martin GB, Rivers EP, Ward K, Smithline HA, Rady MY. Hemodynamics of interposed abdominal compression during human cardiopulmonary resuscitation. Acad Emerg Med. 1994;1(5):498-502. https://doi.org/10.1111/j.1553-2712.1994.tb02536.x https://doi.org/10.1111/j.1553-2712.1994...
-2020 Villa GF, Colombo S, Cabrini L, Scandroglio AM, Torri G. Interposed abdominal compression in mechanical cardiopulmonary resuscitation: description of a clinical case. Minerva Anestesiol [Internet]. 1998[cited 2022 Aug 20];64(9):415-8. Available from: https://pubmed.ncbi.nlm.nih.gov/9835731/ https://pubmed.ncbi.nlm.nih.gov/9835731/...
). - As compressões abdominais foram realizadas com as mãos abertas, uma sobre a outra, centradas sobre o umbigo(1111 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80...
,1313 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900...
,1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
-1818 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800...
), entre o xifoide e o umbigo(2424 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908...
) ou na região epigástrica(1111 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80...
). - Em pacientes intubados, foi realizada ventilação com um aparelho bolsa-válvula-máscara(22 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903...
,1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
-1818 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800...
,2121 Rottenberg EM, Heard J, Hamlin R, Sun BC, Awad H. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: a case report. J Cardiothorac Surg. 2011;6(1):1-4. https://doi.org/10.1186/1749-80906-91 https://doi.org/10.1186/1749-80906-91...
). - Administração de medicações conforme o protocolo da AHA vigente na época do estudo(1111 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80...
-1212 McDonald JL. Effect of interposed abdominal compression during CPR on central arterial and venous pressures. Am J Emerg Med. 1985;3(2):156-9. https://doi.org/10.1016/0735-6757(85)90041-5 https://doi.org/10.1016/0735-6757(85)900...
,1414 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80...
,1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
,2121 Rottenberg EM, Heard J, Hamlin R, Sun BC, Awad H. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: a case report. J Cardiothorac Surg. 2011;6(1):1-4. https://doi.org/10.1186/1749-80906-91 https://doi.org/10.1186/1749-80906-91...
,2323 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2...
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Desfecho Primário
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Desfecho secundário
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- Compressão e elevação abdominal teve restauração da circulação espontânea estatisticamente significativamente maior do que a taxa de compressão torácica [(p < 0,01)(2525 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0...
), (p= 0,049)(2424 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908...
)]. - O retorno da circulação espontânea no grupo que recebeu compressões abdominais interpostas não foi significativamente maior do que para o grupo RCP padrão [p> 0,50)(1212 McDonald JL. Effect of interposed abdominal compression during CPR on central arterial and venous pressures. Am J Emerg Med. 1985;3(2):156-9. https://doi.org/10.1016/0735-6757(85)90041-5 https://doi.org/10.1016/0735-6757(85)900...
,1414 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80...
), (p= 0,07)(1515 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80...
).] - O retorno da circulação espontânea no grupo que recebeu compressões abdominais interpostas foi significativamente maior do que para o grupo RCP padrão [p> 0,05)(2222 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255...
), (p = 0,01)(1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
), (p= 0,007)(1818 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800...
)]. -Retorno da circulação espontânea no paciente estudado(2020 Villa GF, Colombo S, Cabrini L, Scandroglio AM, Torri G. Interposed abdominal compression in mechanical cardiopulmonary resuscitation: description of a clinical case. Minerva Anestesiol [Internet]. 1998[cited 2022 Aug 20];64(9):415-8. Available from: https://pubmed.ncbi.nlm.nih.gov/9835731/ https://pubmed.ncbi.nlm.nih.gov/9835731/...
-2121 Rottenberg EM, Heard J, Hamlin R, Sun BC, Awad H. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: a case report. J Cardiothorac Surg. 2011;6(1):1-4. https://doi.org/10.1186/1749-80906-91 https://doi.org/10.1186/1749-80906-91...
,2323 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2...
). |
-Melhora significativa na frequência cardíaca após reanimação com elevação e compressão abdominal ativa [(p< 0,01)(2525 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0...
), (p<<0,001)(2424 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908...
), (p < 0,001)(2626 Khanghah AG, Moghadamnia MT, Panahi L, Pouy S, Nargesi MA, Leyli EK. Effect of interposed abdominal compression on cardiopulmonary resuscitation outcomes: a randomized clinical trial. Archi Acad Emerg Med. 2022;10(1):e57-e57. https://doi.org/10.22037/aaem.v10i1.1678 https://doi.org/10.22037/aaem.v10i1.1678...
)]. -Melhora significativa na pressão arterial após reanimação com elevação e compressão abdominal ativa [(p< 0,01)(2525 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0...
), (p= 0,003)(2424 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908...
), (p=0,001)(1414 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80...
), (p<0,05)(1212 McDonald JL. Effect of interposed abdominal compression during CPR on central arterial and venous pressures. Am J Emerg Med. 1985;3(2):156-9. https://doi.org/10.1016/0735-6757(85)90041-5 https://doi.org/10.1016/0735-6757(85)900...
), (p<0,001)(1111 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80...
), (p= 0,003)(2828 Wang JP, Zhang YM, Yang RJ, Zhang K, Chai MM, Zhou DC. Efficacy and safety of active abdominal compression-decompression versus standard CPR for cardiac arrests: a systematic review and meta-analysis of 17 RCTs. Int J Surg. 2019;71:132-9. https://doi.org/10.1016/j.ijsu.2019.09.026 https://doi.org/10.1016/j.ijsu.2019.09.0...
)]. -Melhora significativa na saturação de pulso de oxigênio com elevação e compressão abdominal ativa [(p < 0,01)(2525 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0...
), p <0,001)(2424 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908...
)]. -A sobrevida em 24 horas foi igual em ambos os grupos [(p= 1,00)(22 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903...
)]. -A sobrevida em 24 horas foi estatisticamente maior no grupo que recebeu compressões abdominais interpostas [(p= 1,00)(1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
), (p=0,009)(1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
)]. -RCP com compressão abdominal interposta aumentou o CO2 expirado durante a reanimação [(p <0,003)(22 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903...
), (p=0,001)(1515 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80...
). -Taxa de alta hospitalar significativamente maior no grupo que recebeu RCP com compressão abdominal [(p <0,05)(2222 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255...
), (p= 0,02)(1818 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800...
). -Não houve complicação relacionada com as compressões abdominais interposta no grupo de pacientes submetidos a autópsia(1111 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80...
,1616 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900...
-1717 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692...
). -Maior pressão intravascular durante compressões torácicas e abdominais simultâneas(1616 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900...
). -A regurgitação não ocorreu em nenhum paciente(1212 McDonald JL. Effect of interposed abdominal compression during CPR on central arterial and venous pressures. Am J Emerg Med. 1985;3(2):156-9. https://doi.org/10.1016/0735-6757(85)90041-5 https://doi.org/10.1016/0735-6757(85)900...
-1313 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900...
). |
Indicações
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Contraindicações
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- Adultos com idade igual ou superior a 18 anos com quadro de PCR não traumática. |
-Pacientes com histórico de aneurisma na aorta abdominal, ruptura do diafragma, massa abdominal, hemorragia abdominal, câncer nos órgãos abdominais, coagulopatia, hepatoesplenomegalia, cirurgia abdominal recente, obstrução intestinal, ascite, cisto ovariano e gravidez ou suspeita de gravidez. |