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In response to Dr Lerman's letter I have the following comments. I agree that manipulation of airway pressure with a tight thoracoabdominal binder is an effective means for using manipulation of intrathoracic pressure to create carotid blood flow during CPR. As we emphasized previously, in some experimental animals and perhaps in some humans direct cardiac compression appears to occur consistent with the original notion that the heart is compressed between the sternum and vertebral column. At this point it is unclear, but possible, that direct cardiac compression would improve myocardial blood flow over and above that achieved with manipulation of intrathoracic pressures alone. Therefore, until further studies in man and experimental animals have been completed, I would personally consider it inadvisable to abandon sternal displacement during CPR in man.Our article does not deal with high airway pressure ventilation synchronous with chest compression in man but only with
Weisfeldt ML. Abdominal Binding During CPR-Reply. JAMA. 1982;247(6):752–753. doi:10.1001/jama.1982.03320310016007
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