Closed-loop Control for Chest Compression Based on Coronary Perfusion Pressure: A Computer Simulation Study_Journal of Biomedical Engineering

Authors：

CHENAihua , GAOLei , TIANLinhuai , ZHANGJian ,  ZHANNingbo

Military Hospital of 302, Beijing 100039, China;

Corresponding author：

ZHANNingbo, Email: zhan7ng@gmail.com

Keywords：

chest compression; computer simulation; fuzzy control; coronary perfusion pressure

DOI：

10.7507/1001-5515.20140171

Video：

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In this study, a closed-loop controller for chest compression which adjusts chest compression depth according to the coronary perfusion pressure (CPP) was proposed. An effective and personalized chest compression method for automatic mechanical compression devices was provided, and the traditional and uniform chest compression standard neglecting individual difference was improved. This study rebuilds Charles F. Babbs human circulation model with CPP simulation module and proposes a closed-loop controller based on a fuzzy control algorithm. The performance of the fuzzy controller was evaluated and compared to that of a traditional PID controller in computer simulation studies. The simulation results demonstrated that the fuzzy closed-loop controller produced shorter regulation time, fewer oscillations and smaller overshoot than those of the traditional PID controller and outperforms the traditional PID controller in CPP regulation and maintenance.

Citation： CHENAihua, GAOLei, TIANLinhuai, ZHANGJian, ZHANNingbo. Closed-loop Control for Chest Compression Based on Coronary Perfusion Pressure: A Computer Simulation Study. Journal of Biomedical Engineering, 2014, 31(4): 910-916,934. doi: 10.7507/1001-5515.20140171 Copy

1.	VARON J, MARIK P E, FROMM R E. Cardiopulmonary resuscitation: a review for clinicians[J]. Resuscitation, 1998, 36(2): 133-145.
2.	PARADIS N A, MARTIN G B, RIVERS E P, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation[J]. JAMA, 1990, 263(8): 1106-1113.
3.	HALPERIN H R, TSITLIK J E, GELFAND M, et al. A preliminary study of cardiopulmonary resuscitation by circumferential compression of the chest with use of a pneumatic vest[J]. N Engl J Med, 1993, 329(11): 762-768.
4.	NIEMANN J T, CRILEY J M, ROSBOROUGH J P, et al. Predictive indices of successful cardiac resuscitation after prolonged arrest and experimental cardiopulmonary resuscitation[J]. Ann Emerg Med, 1985, 14(6): 521-528.
5.	KERN K B, EWY G A, VOORHEES W D, et al. Myocardial perfusion pressure: a predictor of 24-hour survival during prolonged cardiac arrest in dogs[J]. Resuscitation, 1988, 16(4): 241-250.
6.	LINDNER K H, PRENGEL A W, PFENNINGER E G, et al. Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs[J]. Circulation, 1995, 91(1): 215-221.
7.	LITTLE C M, ANGELOS M G, PARADIS N A. Compared to angiotensin Ⅱ, epinephrine is associated with high myocardial blood flow following return of spontaneous circulation after cardiac arrest[J]. Resuscitation, 2003, 59(3): 353-359.
8.	KERN K B. Coronary perfusion pressure during cardiopulmonary resuscitation[J]. Best Prac Res Clin Anaesthesiol, 2000, 14(3): 591-609.
9.	STEEN S, LIAO Q M, PIERRE L, et al. Evaluation of LUCAS, a new device for automatic mechanical compression and active decompression resuscitation[J]. Resuscitation, 2002, 55(3): 285-299.
10.	YANNOPOULOS D, MCKNITE S, AUFDERHEIDE T P, et al. Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest[J]. Resuscitation, 2005, 64(3): 363-372.
11.	BABBS C F. CPR techniques that combine chest and abdominal compression and decompression: hemodynamic insights from a spreadsheet model[J]. Circulation, 1999, 100(21): 2146-2152.
12.	BABBS C F. Effects of an impedance threshold valve upon hemodynamics in standard CPR: studies in a refined computational model[J]. Resuscitation, 2005, 66(3): 335-345.
13.	BABBS C F. Design of near-optimal waveforms for chest and abdominal compression and decompression in CPR using computer-simulated evolution[J]. Resuscitation, 2006, 68(2): 277-293.
14.	HAMILTON W F, DOW P. Handbook of physiology[M]. Washington DC: American Physiological Society, 1963.
15.	张广,郑捷文,赵鹏,等.胸外按压生理反馈参数的计算机仿真研究[J]. 生物医学工程学杂志,2012,29(6): 1032-1040.
16.	BABBS C F, VOORHEES W D, FITZGERALD K R, et al. Relationship of blood pressure and flow during CPR to chest compression amplitude: evidence for an effective compression threshold[J]. Ann Emerg Med, 1983, 12(9): 527-532.
17.	OTLEWSKI M P, GEDDES L A, PARGETT M, et al. Methods for calculating coronary perfusion pressure during CPR[J]. Cardiovasc Eng, 2009, 9(3): 98-103.
18.	FENELEY M P, MAIER G W, KERN K B, et al. Influence of compression rate on initial success of resuscitation and 24 hour survival after prolonged manual cardiopulmonary resuscitation in dogs[J]. Circulation, 1988, 77(1): 240-250.
19.	COHEN T J, TUCKER K J, REDBERG R F, et al. Active compression-decompression resuscitation: a novel method of cardiopulmonary resuscitation[J]. Am Heart J, 1992, 124(5): 1145-1150.
20.	WIK L, BIRCHER N G, SAFAR P. A comparison of prolonged manual and mechanical external chest compression after cardiac arrest in dogs[J]. Resuscitation, 1996, 32(3): 241-250.
21.	NEUMAR R W, OTTO C W, LINK M S. 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science. Part 8: Adult advanced cardiovascular life support[J]. Circulation, 2010, 122(suppl): S729-S767.

1. VARON J, MARIK P E, FROMM R E. Cardiopulmonary resuscitation: a review for clinicians[J]. Resuscitation, 1998, 36(2): 133-145.
2. PARADIS N A, MARTIN G B, RIVERS E P, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation[J]. JAMA, 1990, 263(8): 1106-1113.
3. HALPERIN H R, TSITLIK J E, GELFAND M, et al. A preliminary study of cardiopulmonary resuscitation by circumferential compression of the chest with use of a pneumatic vest[J]. N Engl J Med, 1993, 329(11): 762-768.
4. NIEMANN J T, CRILEY J M, ROSBOROUGH J P, et al. Predictive indices of successful cardiac resuscitation after prolonged arrest and experimental cardiopulmonary resuscitation[J]. Ann Emerg Med, 1985, 14(6): 521-528.
5. KERN K B, EWY G A, VOORHEES W D, et al. Myocardial perfusion pressure: a predictor of 24-hour survival during prolonged cardiac arrest in dogs[J]. Resuscitation, 1988, 16(4): 241-250.
6. LINDNER K H, PRENGEL A W, PFENNINGER E G, et al. Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs[J]. Circulation, 1995, 91(1): 215-221.
7. LITTLE C M, ANGELOS M G, PARADIS N A. Compared to angiotensin Ⅱ, epinephrine is associated with high myocardial blood flow following return of spontaneous circulation after cardiac arrest[J]. Resuscitation, 2003, 59(3): 353-359.
8. KERN K B. Coronary perfusion pressure during cardiopulmonary resuscitation[J]. Best Prac Res Clin Anaesthesiol, 2000, 14(3): 591-609.
9. STEEN S, LIAO Q M, PIERRE L, et al. Evaluation of LUCAS, a new device for automatic mechanical compression and active decompression resuscitation[J]. Resuscitation, 2002, 55(3): 285-299.
10. YANNOPOULOS D, MCKNITE S, AUFDERHEIDE T P, et al. Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest[J]. Resuscitation, 2005, 64(3): 363-372.
11. BABBS C F. CPR techniques that combine chest and abdominal compression and decompression: hemodynamic insights from a spreadsheet model[J]. Circulation, 1999, 100(21): 2146-2152.
12. BABBS C F. Effects of an impedance threshold valve upon hemodynamics in standard CPR: studies in a refined computational model[J]. Resuscitation, 2005, 66(3): 335-345.
13. BABBS C F. Design of near-optimal waveforms for chest and abdominal compression and decompression in CPR using computer-simulated evolution[J]. Resuscitation, 2006, 68(2): 277-293.
14. HAMILTON W F, DOW P. Handbook of physiology[M]. Washington DC: American Physiological Society, 1963.
15. 张广,郑捷文,赵鹏,等.胸外按压生理反馈参数的计算机仿真研究[J]. 生物医学工程学杂志,2012,29(6): 1032-1040.
16. BABBS C F, VOORHEES W D, FITZGERALD K R, et al. Relationship of blood pressure and flow during CPR to chest compression amplitude: evidence for an effective compression threshold[J]. Ann Emerg Med, 1983, 12(9): 527-532.
17. OTLEWSKI M P, GEDDES L A, PARGETT M, et al. Methods for calculating coronary perfusion pressure during CPR[J]. Cardiovasc Eng, 2009, 9(3): 98-103.
18. FENELEY M P, MAIER G W, KERN K B, et al. Influence of compression rate on initial success of resuscitation and 24 hour survival after prolonged manual cardiopulmonary resuscitation in dogs[J]. Circulation, 1988, 77(1): 240-250.
19. COHEN T J, TUCKER K J, REDBERG R F, et al. Active compression-decompression resuscitation: a novel method of cardiopulmonary resuscitation[J]. Am Heart J, 1992, 124(5): 1145-1150.
20. WIK L, BIRCHER N G, SAFAR P. A comparison of prolonged manual and mechanical external chest compression after cardiac arrest in dogs[J]. Resuscitation, 1996, 32(3): 241-250.
21. NEUMAR R W, OTTO C W, LINK M S. 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science. Part 8: Adult advanced cardiovascular life support[J]. Circulation, 2010, 122(suppl): S729-S767.

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