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Supplemental Digital Content is Available in the Text., Work-related musculoskeletal disorders occur frequently among the endoscopy staff, and patient-handling duties involved with colonoscopy—applying manual pressure and repositioning patients—are particularly physically demanding. This study explored whether the use of a lower abdominal compression device (ColoWrap), previously shown to reduce the need for manual pressure and patient repositioning, would diminish the frequency of staff-reported musculoskeletal pain. A randomized, blinded, sham-controlled clinical trial was performed at the University of North Carolina Hospitals. Three hundred fifty patients had either ColoWrap or a sham device applied before colonoscopy. The primary outcome was the frequency of staff-reported musculoskeletal pain after assisting with colonoscopy. In the intention-to-treat analysis, which included procedures in which ColoWrap was removed, there was no statistical difference in the frequency of staff-reported pain in the control versus ColoWrap arm (4.6% vs. 3.4% of procedures, p = .59). However, when ColoWrap was used as directed (e.g., remained in place for the duration of the procedure), the frequency of staff-reported musculoskeletal pain was significantly reduced (4.6% vs. 0.7% of procedures, p = 0.04). Use of ColoWrap as directed was also found to be independently associated with reduced odds of staff-reported pain relative to the sham arm (OR = 0.12; 95% CI [0.02, 0.95]). When used as directed, ColoWrap reduced the frequency of musculoskeletal pain experienced related to assisting with colonoscopy and may reduce the risk of musculoskeletal disorders and injuries among the endoscopy staff.

Background —This study was done to elucidate mechanisms by which newer cardiopulmonary resuscitation (CPR) techniques, including interposed abdominal compression (IAC), active compression-decompression (ACD), and Lifestick CPR, augment systemic perfusion pressure and forward flow and to compare the 3 techniques in the same test system. Methods and Results —Mathematical models describing hemodynamics of the adult human circulation during cardiac arrest and CPR were created and exercised by use of spreadsheet software. Assumptions of the models are limited to normal human anatomy and physiology, the definition of compliance (volume change/pressure change), and Ohm’s law (flow=pressure/resistance). Standard CPR generates 1.3 L/min forward and 25 mm Hg systemic perfusion pressure. In otherwise identical models, IAC-CPR generates 2.4 L/min and 45 mm Hg; ACD-CPR, 1.6 L/min and 30 mm Hg; and Lifestick CPR, which combines IAC and ACD, 3.1 L/min and 58 mm Hg. Augmented CPR techniques work by enhanced priming of either chest or abdominal pump mechanisms. Conclusions —Adjunctive maneuvers, combined with conventional chest compression, can produce substantial hemodynamic benefit in CPR by credible physiological mechanisms.

The US Food and Drug Administration (FDA) Circulatory System Devices Panel met to discuss the type of data required to effectively evaluate the performance of cardiopulmonary resuscitation (CPR) and hypothermia devices for cardiac arrest patients. Advisory panels make nonbinding recommendations to the FDA. The era of modern CPR began in the 1960s, when mouth-to-mouth ventilation combined with forceful chest compressions were first used together to attempt to resuscitate victims of cardiopulmonary arrest. Unfortunately, despite the promise of a variety of pharmacological, electrical, and mechanical therapies during and after administration of CPR, meaningful improvements in cardiac arrest survival have been difficult to achieve. Earlier generations of CPR devices are designed to assist the rescuer in the performance of CPR. These devices, for example, may compress the chest at a fixed rate and compression depth, or they may provide audible or visual indicators to assist the rescuer with compliance with published CPR guidelines. In general, regulatory guidelines do not require clinical data for these devices as long as they are similar in design and technology to previously marketed “predicate” devices. More than 30 devices for external compression and/or timing assistance during CPR have been cleared for marketing by the FDA. Devices intended to enhance a clinical aspect of CPR, in contrast to devices designed simply to assist the rescuer in the performance of CPR, require clinical data to support approval of the device. These devices, such as those providing interposed abdominal compression, circumferential chest compression, or active compression-decompression, have focused primarily on enhancing hemodynamics during CPR. Despite great interest in improving CPR survival rates, no device intended to enhance hemodynamics during CPR has been approved by the FDA for marketing in the United States. The Circulatory System Devices Panel was asked to discuss and make recommendations about the type of clinical data …

The purpose of this study was to compare the efficacy of standard cardiopulmonary resuscitation and cardiopulmonary resuscitation with interposed abdominal compression for restoration of spontaneous circulation in an asphyxial and fibrillatory arrest model. Twenty-eight pigs weighing 19-27 kg were randomly allocated to two arrest groups. Each of these two groups was then subdivided into a treatment group and a control group resulting in four groups of seven pigs each. In the control groups standard cardiopulmonary resuscitation was performed with a pneumatically driven chest compressor at a rate of 80 beats per min. The animals' lungs were ventilated at a respiratory rate of 20 breaths per min independently of chest compression. In the treatment group, in addition to standard cardiopulmonary resuscitation, manual interposed abdominal compression was applied at the midabdomen in the second half of the relaxation phase using a blood pressure cuff to measure and standardize the compressions. Following asphyxial cardiac arrest of 3 min, none of the seven animals could be resuscitated with standard cardiopulmonary resuscitation, whereas all seven animals could be resuscitated with interposed abdominal compression and standard cardiopulmonary resuscitation after 240 +/- 84 s. Following fibrillatory cardiac arrest of 4 min, none of the seven animals that received standard cardiopulmonary resuscitation and countershocks could be resuscitated. In the group that received standard cardiopulmonary resuscitation and interposed abdominal compression spontaneous circulation was achieved in all animals in 244 +/- 117 s. End-diastolic arteriovenous pressure difference, which correlates with coronary blood flow, was significantly higher with interposed abdominal compression during resuscitation from both forms of cardiac arrest. The results of our study indicate that cardiopulmonary resuscitation with interposed abdominal compression in the second half of the relaxation phase improves diastolic arteriovenous pressure difference and resuscitation success in comparison with that following standard cardiopulmonary resuscitation. The use of interposed abdominal compression during basic cardiac life support should be investigated further in patients.

Background: Abdominal compression (Ac) to facilitate scope advancement may cause hand injury in endoscopy assistants. To minimize insertion discomfort, 85% vs. 57% required Ac when air insufflation (AI) and water exchange (We) were compared in unsedated colonoscopy. Aim: To compare the need for abdominal compression during colonoscopy using AI, We and water immersion (WI). We hypothesize that We significantly reduces need for Ac compared to AI and WI. Methods: A performance improvement project involved 8 endoscopists using AI (n=2), WI (n=3) and We (n=3) for sedated colonoscopy. (AI): conventional colonoscopy with air; (WI): water was infused to facilitate scope insertion and was removed mainly during scope withdrawal; (We): water was infused and removed predominantly on scope insertion, air button was off till cecum was reached and air was used on scope withdrawal. consecutive patients were scheduled with endoscopists and colonoscopy was performed with technique based on endoscopists’ preference. With insertion difficulty abdominal compression was applied by the assistant and/or patient was repositioned to facilitate scope advancement. Results: 259 patients were included, 6 were excluded due to poor bowel prep (n=2) and prior colonic resection (n=4). Abdominal compression and/or position change, and procedural outcomes were compared. There was a significant difference between We vs. WI and AI colonoscopy in need for abdominal compression but no significant difference between WI and AI. Conclusion: Water exchange colonoscopy required significantly less abdominal compression compared to WI or AI method and may potentially minimize risk of hand injury among endoscopy assistants.

Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to nonobese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to nonobese patients), difficulty may be encountered in positioning the patient so that the stone is situated at the F2 focal point of the lithotriptor. Using various aids, such as the extended shock pathway and abdominal compression, we treated 81 patients weighing more than 300 pounds using the Medstone STS tubless second generation lithotriptor. The stone-free rate at 3 months or longer was 68%, with another 10% having asymptomatic fragments of 4 mm. or less in diameter. Thus, a clinical stone-free rate of 78% was achieved. The retreatment rate was 11% and the post-lithotripsy secondary procedures rate was 3%. Since these results are comparable to those obtained when treating patients less than 300 pounds, extracorporeal shock wave lithotripsy can be used successfully to treat urolithiasis in morbidly obese patients.

The authors studied the effects of positive end-expiratory pressure (10 cmH2O PEEP), abdominal compression, and neck compression on dural venous sinus pressure (VSP) in seated dogs. Abdominal compression increased the central venous pressure (CVP) as well as both the systemic arterial pressure and the cardiac output and thus may offer a useful substitute for an antigravity suit. Except when CVP was greater than 8 mmHg, there was little or no correlation between CVP and VSP. Moreover, each method increased VSP, but this effect was closely related to VSP prior to application of the method (pre-VSP). On comparing the VSP changes in relation to the pre-VSP levels when they were either above or below -1.0 mmHg, significant differences were noted in VSP increases, i.e., -0.4 +/- 1.3 (mean +/- SEM) and 4.3 +/- 1.2 mmHg by PEEP, 1.9 +/- 0.3 and 6.4 +/- 0.4 mmHg by abdominal compression, and 10.2 +/- 1.3 and 1.5 +/- 0.5 mmHg by neck compression, respectively. This indicates that PEEP and abdominal compression were more effective in increasing relatively highly negative pre-VSP (less than -1.0 mmHg), while neck compression greatly increased pre-VSP when it was at or above a slightly negative pressure (-1.0 mmHg). The authors conclude that a single application of any one of these three methods during sitting-position surgery may not be effective in increasing cerebral dural sinus pressure.

Intravenous urography is optimally performed using abdominal compression for distention of the pyelocalyceal systems. Because of real and potential difficulties with the application of compression, the authors have tested in dogs the alternative of administering glucagon as a means of improving pyelocalyceal distention and ureteral visualization. In six greyhound dogs, ureteral peristalsis transiently ceased following the intravenous injection of glucagon. Objective and coded subjective analyses showed statistically significant improvement in demonstration of collecting systems and ureters when urograms were performed with glucagon, as compared with those in which the drug was not administered. The success of glucagon in improving pyeloureteral visualization in dogs encourages its experimental use in human subjects as an alternative to abdominal compression.

Lateral impacts of automobiles frequently result in abdominal injury to the occupants. While there have been important advances in the clinical management of this lateral impact trauma, the abdominal tolerance to injury from lateral impacts remains uncertain. The present report describes a series of 117 experiments in which the effect of changing the impact velocity and the forced abdominal compression upon the abdominal injuries sustained was monitored. The impact velocity was varied from 3 to 15 m/s, and the abdominal compression was varied from 10 to 50%. Serious injuries (AIS greater than or equal to 3) occurred in the following proportions of the total number of serious injuries: renal (54%), hepatic (44%), and splenic (1%). Impact side was a significant factor in hepatic and splenic tolerance, but not in renal tolerance. An abdominal injury criterion (AIC) is proposed which is a function of the impact velocity times the forced abdominal compression, but more work is necessary before it can be applied to human beings.