Time to Resuscitate Cardiopulmonary Resuscitation: The 3R/CPR Refill-Recoil-Rebound
Cardiology and Angiology: An International Journal,
Introduction: Sudden cardiac arrest (SCA) remains a major healthcare issue worldwide with gloomy outcomes due to poor perfusion of cardiopulmonary resuscitation (CPR), deemed unsuitable for hemostatic conditions, cardiotorsal anatomy, electrophysiology, and thoracic biomechanics. Alternatively, we propose a new management, implementing rational exploitation of the stagnant blood masses: manually with a novel technique of cardiac massage and mechanically with a circulatory flow restoration (CFR) device.
Methods: Simulated chest compressions were performed through the 5th intercostal space in professional Lifeguards volunteers, placed in the left lateral decubitus position with raised legs and abdominal compression.
Results: Bypassing the sternal barrier, refilling the heart, and then compressing the chest with a recoil-rebound maneuver (3R / CPR) can significantly promote return of spontaneous circulation (ROSC). The effectiveness of the CFR device versus CPR has previously been demonstrated in the literature.
Conclusion: Unlike current CPR, the 3R/CPR adapts human morphology and provides adequate myocardial perfusion promoting ROSC safely, under all circumstances. Preclinical computational models can confirm the effectiveness of the technique.
- Sudden cardiac arrest
- cardiopulmonary resuscitation (CPR)
- circulatory flow resuscitation (CFR)
- thoracic biomechanics
How to Cite
Corrado D, Basso C, Thiene G. Sudden cardiac death in young people with apparently normal heart. Cardiovasc Res. 2001;50:399–408.
Wick R, Gilbert JD, Byard RW. Cafe coronary syndrome fatal choking on food: An autopsy approach. J Clin Forensic Med. 2006;13:135–8.
Link MS. Mechanically induced sudden death in chest wall impact (commotio cordis). Prog Biophys Mol Biol. 2003; 82:175–86.
Thygesen K, Uretsky B F. Acute ischaemia as a trigger of sudden cardiac death. Eur Heart J. 2004; 6(Suppl.):D88–D90.
Marcus FI, McKenna WJ, Sherrill D, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121: 1533–41.
Wukasch DC, Reul GJ, Milam JD, et al. The «stony heart» syndrome. Surgery. 1972;72 (6):1071-1080.
William A, Gay Jr., Ebert PA. Functional, metabolic, and morphologic effects of potassium-induced cardioplegia. Surgery. 1973;74(2):284-290.
Engdahl J, Bång A, Karlson BW, et al. Characteristics and outcome among patients suffering from out of hospital cardiac arrest of non-cardiac aetiology. Resuscitation. 2003;57:33-41.
de la Grandmaison GL. Is there progress in the autopsy diagnosis of sudden unexpected death in adults? Forensic Sci Int. 2006;156:138-44.
Brooks SC, Bigham BL, Morrison LJ. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev. 2011;CD007260.
Vaillancourt C, Stiell IG. Canadian Cardiovascular Outcomes Research Team (CCORT) cardiac arrest care and emergency medical services in Canada. Can J Cardiol. 2004;20:1081–90.
Deo R, Albert CM. Epidemiology and genetics of sudden cardiac death. Circulation. 2012;125:620-37.
Goyal A, Sciammarella JC, Cusick AS, et al. Cardiopulmonary Resuscitation. [Updated 2021 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
Peura JL, Colvin-Adams M, Francis GS, et al. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: A scientific statement from the American Heart Association. Circulation. 2012;126: 2648–67.
Nolan JP, Soar J. Defibrillation in clinical practice. Curr Opin Crit Care. 2009; 15:209–15.
Coats AJ. MADIT II, the multi-center autonomic defibrillator implantation trial II stopped early for mortality reduction, has ICD therapy earned its evidence-based credentials? Int J Cardiol. 2002;82:1–5.
Niemann JT, Cairns CB, Sharma J, Lewis RJ. Treatment of prolonged ventricular fibrillation. Immediate countershock versus high-dose epinephrine and CPR preceding countershock. Circulation. 1992;85:281–7.
Plaisier BR. Thoracic lavage in accidental hypothermia with cardiac arrest--report of a case and review of the literature. Resuscitation. 2005;66:99-104.
Lasa JJ, Rogers RS, Localio R, et al. Extracorporeal Cardiopulmonary Resuscitation (E-CPR) during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge: A report from the american heart association's get with the guidelines-resuscitation (GWTG-R) Registry. Circulation. 2016;133:165-76.
Kern KB, Morley PT, Babbs CF, et al. Use of adjunctive devices in cardiopulmonary resuscitation. Ann Emerg Med. 2001; 37:68–77.
Rubertsson S, et al. Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: The LINC randomized trial. JAMA. 2014;311:53-61.
Perkins GD, Ji C, Deakin CD, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med. 2018;379:711-72.
Panchal AR, Bartos JA, Cabañas JG, et al. Adult basic and advanced life support writing group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S366-S468.
Peberdy MA, Callaway CW, Neumar RW, et al. Part 9: Post-cardiac arrest care: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122:768–86.
Oeser C. Cardiac resuscitation: continuous chest compressions do not improve outcomes. Nat Rev Cardiol. 2016;13:5.
Nour S, Carbognani D, Chachques JC. Circulatory flow restoration versus cardiopulmonary resuscitation: new therapeutic approach in sudden cardiac arrest. Artif Organs. 2017;41:356-366.
Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed chest cardiac massage. JAMA. 1960;173:1064–7.
Mery A, Almond F, Menard C, et al. Initiation of embryonic cardiac pacemaker activity by inositol 1,4,5-trisphosphate–dependent calcium signaling. Mol Biol Cell. 2005;16:2414–23.
Hachida M, Saitou S, Nonoyama M, et al. Mechanisms of exercise response in the denervated heart after transplantation. Transplant Proc. 1999;31: 1966–9.
Schwerzmann M, Salehian O, Harris L, et al. Ventricular arrhythmias and sudden death in adults after a Mustard operation for transposition of the great arteries. Eur Heart J. 2009;30:1873–9.
Anderson RM, The Gross Physiology of the Cardiovascular System. San Carlos PL, Tucson, AZ: Racquet Press. 4625; 1999.
Arbogast KB, Maltese MR, Nadkarni VM, et al. Anterior-posterior thoracic force-deflection characteristics measured during cardiopulmonary resuscitation: Comparison to post-mortem human subject data. Stapp Car Crash J. 2006;50:131-45. PMID: 17311162.
Beck, B. S. The developments of a new blood supply to the heart by operation. Ann Surg.1935;102:809-13.
Mangold S, Miller S, Aebert H. Rupture of the right ventricle after closed-chest cardiac massage. Circulation. 2010;122: 1657.
Reynolds JC, Salcido DD, Menegazzi JJ. Coronary perfusion pressure and return of spontaneous circulation after prolonged cardiac arrest. Prehosp Emerg Care. 2010;14:78–84.
Bardy GH, Lee KL, Mark DB, et al. Home use of automated external defibrillators for sudden cardiac arrest. N Engl J Med. 2008;358:1793–804.
Ohuchi K, Fukui Y, Sakuma I, et al. A dynamic action potential model analysis of shock-induced aftereffects in ventricular muscle by reversible breakdown of cell membrane. IEEE Trans Biomed Eng. 2002;49:18–30.
Stallinger A, Wenzel V, Oroszy S, et al. The effects of different mouth-to-mouth ventilation tidal volumes on gas exchange during simulated rescue breathing. Anesth Analg. 2001;93:1265-9.
Breil M, Gräsner JT, Schewe JC, et al. Randomised study of hypertonic saline infusion during resuscitation from outof- hospital cardiac arrest. Resuscitation. 2012;83:347–52.
Polimenakos AC, Rizzo V, El-Zein CF, et al. Postcardiotomy rescue extracorporeal cardiopulmonary resuscitation in neonates with single ventricle after intractable cardiac arrest: attrition after hospital discharge and predictors of outcome. Pediatr Cardiol. 2017;38:314–23.
Idris AH, Bierens JJLM, Perkins GD, et al. Revised Utstein-Style Recommended Guidelines for Uniform Reporting of Data From Drowning-Related Resuscitation: An ILCOR Advisory Statement. Circ Cardiovasc Qual Outcomes. 2017; 10:e000024.
Heimlich HJ. Subdiaphragmatic pressure to expel water from the lungs of drowning persons Ann Emerg Med. 1981;10: 476-480.
Venema AM, Groothoff JW, Bierens JJ. The role of bystanders during rescue and resuscitation of drowning victims. Resuscitation. 2010;81:434-9.
Franklin RC, Peden AE, Hamilton EB, et al. The burden of unintentional drowning: global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study Injury Prevention. 2020;26:i83-i95.
Lee DG. Biomechanics of the thorax - research evidence and clinical expertise. J Man Manip Ther. 2015;23(3):128-138.
Nour S, Dai G, Wang Q, et al. The forgotten driving forces in right heart failure (Part II): experimental study. Asian Cardiovasc Thorac Ann. 2012;20:646–57.
Taylor D, Lee TC. Microdamage and mechanical behaviour: Predicting failure and remodelling in compact bone. J Anat. 2003;203(2):203-211.
Jang SJ, Cha YK, Kim JS, et al. Computed tomographic findings of chest injuries following cardiopulmonary resuscitation: More complications for prolonged chest compressions? Medicine (Baltimore). 2020;99:e21685.
Yamaguchi R, Makino Y, Chiba F, et al. Frequency and influencing factors of cardiopulmonary resuscitation-related injuries during implementation of the American Heart Association 2010 Guidelines: a retrospective study based on autopsy and postmortem computed tomography. Int J Legal Med. 2017; 131:1655-1663.
Gupta V, Mittal M, Mittal V. R-peak detection based chaos analysis of ECG signal. Analog Integr Circ Sig Process. 2020;102:479–490.
Allen BS, Buckberg GD. Studies of isolated global brain ischaemia: I. Overview of irreversible brain injury and evolution of a new concept – redefining the time of brain death. Eur J Cardiothorac Surg. 2012; 41:1132-7.
Podsiadło, P, Darocha, T, Svendsen, ØS, et al. Outcomes of patients suffering unwitnessed hypothermic cardiac arrest rewarmed with extracorporeal life support: A systematic review. Artif Organs. 2021; 45:222–229.
Undar A, Wang S, Izer JM, Clark JB, et al. The clinical importance of pulsatile flow in extracorporeal life support: the Penn state health approach. Artif Organs. 2016; 40:1101–4.
Nour S, Liu J, Dai G, et al. Shear stress, energy losses and costs: A resolved dilemma of pulsatile cardiac assist devices. Biomed Res Int. 2014;2014:651769.
Nour S. Endothelial shear stress enhancements: A potential solution for critically ill Covid-19 patients. BioMed Eng OnLine. 2020;19:91.
Nour S. New hemodynamic theory “Flow and Rate”: Concept and clinical applications using new pulsatile circulatory assist devices. Ph.D. Thesis, Therapeutic Innovations, University Paris Sud, Paris XI; Français. 2012. NNT:2012PA114862.
DeVore AD, Al-Khatib SM. ICDs are still an effective therapy to prevent sudden cardiac death in heart failure. JACC Heart Fail. 2019;7(10):907-910.
DOI: 10.1016/j.jchf.2019.08.001. Epub 2019 Sep 11. PMID: 31521688.
Brugada J, Brugada P. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol. 1992; 20:1391–6.
Wei J, Tung D, Sue SH, Wu SV, Chuang YC, Chang CY. Cardiopulmonary resuscitation in prone position: a simplified method for outpatients. J Chin Med Assoc. 2006;69(5):202-6.
DOI: 10.1016/S1726-4901(09)70219-9. PMID: 16835981
Jamaludin FH, et al. Simulation and evaluation of the protective barrier enclosure for cardiopulmonary resuscitation. Resusc Plus. 2021; 8:100180.
Guan A, Hamilton P, Wang, et al. Medical devices on chips. Nat Biomed Eng. 2017; 1:45–10.
John AR, et al. Computer-Based CPR Simulation Towards Validation of AHA/ERC Guidelines. Cardiovasc Eng Technol. 2017;8:229-235.
Hulley SB, Cummings SR, Browner WS, et al. Designing clinical research. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2013.
Pocock S J, Clayton TC, Stone DW. Challenging issues in clinical trial design Part 4 of a 4-part series on statistics for clinical trials. Jam Coll Cardiol. 2015; 66:2886-2898.
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