Can the CMP be Used for Circulation in CPR and Cardiac Arrest Situations?

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Discussion Overview

The discussion centers around the potential use of the calf muscle pump (CMP) for blood circulation in CPR and cardiac arrest situations, exploring its viability as an alternative method for maintaining blood flow, especially in cases of torso injuries. Participants examine the physiological mechanisms of the CMP, its effectiveness compared to standard CPR techniques, and the implications of muscle contraction in this context.

Discussion Character

  • Exploratory
  • Debate/contested
  • Technical explanation

Main Points Raised

  • Some participants propose that the CMP could serve as a secondary means of circulation, particularly if electric stimulation is employed to activate the muscles.
  • Others argue that the CMP primarily aids venous return and may not generate sufficient pressure to drive systemic blood flow effectively.
  • A participant mentions that standard CPR techniques can cause damage to the sternum and ribs, raising concerns about the potential harm of traditional methods.
  • There is a suggestion that elevating the legs could help auto-transfuse blood back to the heart in cases of low blood volume, although this remains speculative.
  • Some participants note the lack of evidence supporting the effectiveness of the CMP in cardiac arrest situations, emphasizing that traditional chest compressions are currently recommended for effective CPR.
  • Discussion includes references to existing CPR guidelines and the potential for alternative devices, such as LVADs, to assist in circulation.

Areas of Agreement / Disagreement

Participants express a range of views, with no consensus on the effectiveness of the CMP for circulation in CPR. While some support the exploration of the CMP, others firmly reject its viability, leading to an unresolved discussion.

Contextual Notes

Limitations include the dependency on definitions of muscle pump functionality, the need for further evidence regarding the efficacy of the CMP in CPR, and the unresolved nature of the physiological mechanisms involved in muscle contraction and blood flow during cardiac arrest.

Elite Jacob
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The CMP (calf muscle pump) is referred to as the body's second heart. Would it be possible to use it to circulate blood for someone who had a wound or injury in the torso? If part of its function requires the voluntary use of the muscles by the subject, than can an electric stimulation apparatus be used. It might be useful if the person who needed CPR was larger than the person administering.
 
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What studies have you read that suggest this as a viable alternative? Please post the links.
 
Elite Jacob said:
The CMP (calf muscle pump) is referred to as the body's second heart. Would it be possible to use it to circulate blood for someone who had a wound or injury in the torso? If part of its function requires the voluntary use of the muscles by the subject, than can an electric stimulation apparatus be used. It might be useful if the person who needed CPR was larger than the person administering.
The recommended resuscitation procedures are reviewed every 5 years by an organization called ILCOR. The last one was in 2010. The process is evidence-based and the evaluation procedures are quite systematic. Hundreds of studies are reviewed - and I have read at least the summaries of all of the ones that seemed to me to be related to CPR procedures. There were no citations of any studies related to the "Calf Muscle Pump".

http://www.ilcor.org/consensus-2010/worksheets-2010/

If you download the worksheet index, you're looking for "Part 7" worksheets.
 
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I believe the OP meant the muscle pump. Although the wikipedia article seems to refer to some effects on arterial blood flow, it is more commonly thought that the muscle pump only aids in venous return via the little "check valves" that are found in our veins. Thus, it is unlikely that you can get enough of a pressure differential to drive systemic blood flow by squeezing someone's calf. Also, bear in mind that you would probably need to somehow compress and relax all of the muscles in the body in a fairly regular manner.

I'm going with "no, its probably not the best way to perform CPR."
 
I was aware of this after watching a combat medic attempt to revive a wounded soldier. The trauma/damage caused by the bullet may have been repairable if there was another way to keep his blood flowing and providing oxygen to the brain until he could be stabilized. From what I saw the standard CPR technique of compression may have actually caused more damage because of a build up of internal fluids. If while laying down the legs could be raised and lowered while bending the foot the CMP would circulate some blood. Again another question that needs to be answered is wether simply moving the muscles moves the blood or if muscles have to be contracted with an impulse.
 
Doug Huffman said:
Proper chest compression of two inches / 5 cm. will likely cause damage to the sternum/ribs and trauma.
It's been known for some time that standard CPR can cause damage.
 
Yes, I qualified EMT in the Eighties and practiced under Dr. Norman McSwain.
 
Doug Huffman said:
Proper chest compression of two inches / 5 cm. will likely cause damage to the sternum/ribs and trauma.
Just to be clear, the current AHA recommendation (2010) is "at least" two inches (5cm).
Here is an article that not only specifies the 2010 recommendations but provides some of the rational behind them:
http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf
 
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It may be worth lifting the legs to auto transfuse blood back to the heart in an arrest situation especially if low blood volume was the cause such as in blood loss, dehydration...

There is no evidence that squeezing the legs will help in an arrest situation, we do use calf compression devices for patients after surgery to prevent blood becoming static in the veins while they recuperate in bed as static blood can clot and then Break off and travel to the heart causing a cardiac arrest. Squeezing the calf muscle propels the blood forward but this wouldn't be enough to assist blood flow in an arrest situation.

There is the concept of a thoracic pump whereby expanding and contracting the chest may improve circulation but the best method is chest compressions causing cardiac compression. Good cpr allows you to feel a good radial peripheral pulse and I have seen a patient in cardiac arrest receiving cpr for over an hour before return of spontaneous circulation that then walked out of hospital for home 3 days later with no neurological injury.

Some cardiac patients with low cardiac output flow States have a sausage like balloon pump inserted into the aorta which inflates and deflates In timing with the cardiac contractions which helps to improves coronary artery flow.

LVAD left ventricle assist devices can be inserted in patients awaiting heart transplant. They can be thought of as artificial mechanical pumps to help assist the natural failing heart.
 

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