Echocardiographic clues of the "atrial pump mechanism" during cardiopulmonary resuscitation

• Published in: Internal and emergency medicine 2024-09
• Main Authors: Catena, Emanuele, Volontè, Alessandra, Fossali, Tommaso, Ballone, Elisa, Bergomi, Paola, Locatelli, Martina, Borghi, Beatrice, Ottolina, Davide, Rech, Roberto, Castelli, Antonio, Colombo, Riccardo
• Format: Article
• Language: English
• ISSN: 1828-0447; 1970-9366; 1970-9366
• DOI: 10.1007/s11739-024-03762-w

Instead of the ventricles, atria may be the cardiac structures mainly compressed during cardiopulmonary resuscitation (CPR). This study aimed to assess the prevalence and the mechanical characteristics of atrial compression, named the "atrial pump mechanism", in patients undergoing CPR. A retrospective cohort study was conducted on patients with witnessed refractory out-of-hospital cardiac arrest who were admitted to a tertiary referral center for extracorporeal CPR. The area of maximal compression (AMC) by chest compressions was assessed by transesophageal echocardiography. Right atrial wall excursion (RA ), left atrial fractional shortening (LA ), right ventricular fractional area change (RV ), and left ventricular fractional shortening (LV ) were measured. Common carotid and middle cerebral artery peak velocities were assessed using color-Doppler imaging as markers of cardiac outflow and cerebral perfusion. Forty patients were included in the study. Five (12.5%) had AMC over the atria. The atrial pump pattern was characterized by marked atrial compression with higher RA and LA values compared to the other patients (p