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首页> 外文期刊>Resuscitation. >Design of near-optimal waveforms for chest and abdominal compression and decompression in CPR using computer-simulated evolution.
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Design of near-optimal waveforms for chest and abdominal compression and decompression in CPR using computer-simulated evolution.

机译：使用计算机模拟的演化设计心肺复苏术中胸部和腹部受压和减压的最佳波形。

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OBJECTIVE: To discover design principles underlying the optimal waveforms for external chest and abdominal compression and decompression during cardiac arrest and cardiopulmonary resuscitation (CPR). METHOD: A 14-compartment mathematical model of the human cardiopulmonary system is used to test successive generations of randomly mutated external compression waveforms during cardiac arrest and resuscitation. Mutated waveforms that produced superior mean perfusion pressure became parents for the next generation. Selection was based upon either systemic perfusion pressure (SPP = thoracic aortic minus right atrial pressure) or upon coronary perfusion pressure (CPP = thoracic aortic pressure minus myocardial wall pressure). After simulations of 64,414 individual CPR episodes, 40 highly evolved waveforms were characterized in terms of frequency, duty cycle, and phase. A simple, practical compression technique was then designed by combining evolved features with a constant rate of 80 min(-1) and duty cycle of50%. RESULTS: All ultimate surviving waveforms included reciprocal compression and decompression of the chest and the abdomen to the maximum allowable extent. The evolved waveforms produced 1.5-3 times the mean perfusion pressure of standard CPR and greater perfusion pressure than other forms of modified CPR reported heretofore, including active compression-decompression (ACD)+ITV and interposed abdominal compression (IAC)-CPR. When SPP was maximized by evolution, the chest compression/abdominal decompression phase was near 70% of cycle time. When CPP was maximized, the abdominal compression/chest decompression phase was near 30% of cycle time. Near-maximal SPP/CPP of 60/21 mmHg (forward flow 3.8 L/min) occurred at a compromise compression frequency of 80 min(-1) and duty cycle for chest compression of 50%. CONCLUSIONS: Optimized waveforms for thoraco-abdominal compression and decompression include previously discovered features of active decompression and interposed abdominal compression. These waveforms canbe used by manual (Lifestick-like) and mechanical (vest-like) devices to achieve short periods of near normal blood perfusion non-invasively during cardiac arrest.
机译：目的：发现在心脏骤停和心肺复苏（CPR）过程中用于外部胸部和腹部压缩和减压的最佳波形的设计原理。方法：使用一个由14个房间组成的人体心肺系统数学模型来测试在心脏骤停和复苏过程中连续产生的随机突变的外部压缩波形。产生优异平均灌注压力的突变波形成为下一代的父母。选择的依据是全身性灌注压力（SPP =胸主动脉减去右心房压力）或冠状动脉灌注压力（CPP =胸主动脉压力减去心肌壁压力）。在对64,414个单独的CPR事件进行仿真之后，根据频率，占空比和相位对40个高度发展的波形进行了表征。然后，通过结合具有80 min（-1）的恒定速率和50％的占空比的演进特征来设计一种简单实用的压缩技术。结果：所有最终存活的波形包括最大程度允许的胸部和腹部的相互压缩和减压。进化后的波形产生的平均灌注压力是标准CPR的1.5-3倍，并且比迄今为止报道的其他形式的改良CPR（包括主动压缩-减压（ACD）+ ITV和介入性腹部压缩（IAC）-CPR）更高。当通过进化使SPP最大化时，胸部按压/腹部减压阶段接近周期时间的70％。当CPP最大化时，腹部压迫/胸部减压阶段接近周期时间的30％。 60/21 mmHg（向前流量3.8 L / min）的接近最大SPP / CPP发生在折衷的压缩频率为80 min（-1），胸部压缩率为50％的情况下。结论：胸腹压缩和减压的最佳波形包括先前发现的主动减压和介入腹部压缩的特征。这些波形可以由手动（救生棒式）和机械（背心式）设备使用，以在心脏骤停期间以非侵入性的方式实现短时间的接近正常血液灌注。

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