Acidosis in CPR: Pathophysiology and Treatment
During cardiac arrest and cardio-pulmonary resuscitation (CPR) only limited blood flow and consequently organ perfusion can be maintained by chest compression. Cardiac output during CPR averages only 25 to 35% of normal and thus severely reduces oxygen delivery to the tissues. The metabolism therefore turns to its energetic emergency pathway resulting in the production of anaerobic metabolites. The buildup of lactic acid is slow, while the CO2 concentration rapidly increases during CPR. After onset of cardiac arrest intramyocardial CO2 progressively increases to levels exceeding 400 mmHg. These increases in CO2 can only be reversed by improving coronary blood flow and its associated oxygen delivery.
KeywordsCardiac Arrest Cardiopulmonary Resuscitation Coronary Blood Flow Chest Compression Limited Blood Flow
Unable to display preview. Download preview PDF.
- 6.von Planta I, Weil MH, von Planta M, et al (1988) Cardiopulmonary resuscitation in the rat. J Appl Physiol 65:2641–2647Google Scholar
- 10.Brantigan JW, Perna AM, Gardner TJ, Gott VL (1972) Intramyocardial gas tensions in the canine heart during anoxic cardiac arrest. Surg Gyn Obstet 134:67–72Google Scholar
- 11.MacGregor DC, Wilson GJ, Holness DE, et al (1974) Intramyocardial carbon dioxide tension: A guide to the safe period of anoxic arrest of the heart. J Thor Cardiovasc Surg 68:101–107Google Scholar
- 12.Kette F, Weil MH, Gazmuri RJ, Bisera J, Rackow EC (1989) Increases in myocardial PC02 during CPR correlate inversely with coronary perfusion pressures (CPP) and resuscitability (Abstract). Circulation 80 (in press)Google Scholar
- 15.Koretsune Y, Marban G (1989) Cell calcium in the pathophysiology of ventricular fibrillation and in the pathogenesis of postarrhythmic contractile function. Circulation 80:369–379Google Scholar
- 17.von Planta M, Gudipati CV, Weil MH, Kraus LJ, Rackow EC (1988) Effects of tromethamine and sodium bicarbonate buffers during cardiac resuscitation. J Clin Pharmacol 28:594–599Google Scholar
- 20.Gazmuri RJ, von Planta M, Weil MH, Rackow EC (1990) Cardiac effects of CO2 consuming and CO2 generating buffers during cardiopulmonary resuscitation. J Am Coll Cardiol (in press)Google Scholar