Post-resuscitation Arterial Blood Pressure on Survival and Change of Capillary Density Following Cardiac Arrest and Resuscitation in Rats

Blood losses are usually corrected initially by the restitution of volume with plasma expanders and subsequently by the restoration of oxygen-carrying capacity using either a blood transfusion or possibly, in the near future, oxygen-carrying plasma expanders. The present study was carried out to test the hypothesis that high-plasma viscosity hemodilution maintains perfused functional capillary density (FCD) by preserving capillary pressure. Microvascular pressure responses to extreme hemodilution with low- (LV) and high-viscosity (HV) plasma expanders and an exchange transfusion with a polymerized bovine cell-free Hb (PBH) solution were analyzed in the awake hamster window chamber model ( n = 26). Systemic hematocrit was reduced from 50% to 11%. PBH produced a greater mean arterial blood pressure than the nonoxygen carriers. FCD was higher after a HV plasma expander (70 ± 15%) vs. PBH (47 ± 12%). Microvascular pressure spanning the capillary network was higher after a HV plasma expander (16–19 mmHg) compared with PBH (12–16 mmHg) and a LV plasma expander (11–14 mmHg) but lower than control (22–26 mmHg). FCD was found to be directly proportional to capillary pressure. The use of a HV plasma expander in extreme hemodilution maintained the number of perfused capillaries and tissue perfusion by comparison with a LV plasma expander due to increased mean arterial blood pressure and capillary pressure. The use of PBH increased mean arterial pressure but reduced capillary pressure due to vasoconstriction and did not maintain FCD.

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Critical Closing Pressure: Comparison of Three Methods

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2009.24 ◽

2009 ◽

Vol 29 (5) ◽

pp. 987-993 ◽

Cited By ~ 14

Author(s):

Jorge A López-Magañna ◽

Hugh K Richards ◽

Danila K Radolovich ◽

Dong-Joo Kim ◽

Peter Smielewski ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Arterial Blood Pressure ◽

Transcranial Doppler ◽

Cerebrovascular Circulation ◽

Waveform Analysis ◽

Arterial Blood ◽

Pressure Threshold ◽

Critical Closing Pressure ◽

Closing Pressure

Critical closing pressure (CCP) is an arterial pressure threshold below which small arterial vessels collapse. Our aim was to compare different methods to estimate CCP in the cerebrovascular circulation using the relationships between transcranial Doppler flow velocity (FV), laser-Doppler flux (LDF), and arterial blood pressure (ABP). A total of 116 experiments in rabbits were analyzed retrospectively. At the end of each recording, cardiac arrest (CA) was induced. Arterial blood pressure in femoral artery, basilar artery FV, cortical blood LDF, intracranial pressure (ICP) was recorded. Critical closing pressure was estimated using linear regression between decreasing mean ABP values, FV, and LDF during CA. In addition, CCP was calculated from FV waveform just before CA. The correlation between CCP evaluated using LDF and FV during CA was 0.98 ( P < 0.0001). The correlation between CCP measured during CA and CCP estimated from the transcranial Doppler ultrasonography (TCD) waveform was weaker ( R=0.39; P <0.001), with CCP calculated from waveform being significantly greater than CCP from CA (median difference 9 mm Hg; P < 0.003). Critical closing pressures obtained from FV waveform and CA correlated with mean ICP before CA ( R = 0.40; P = 0.001). In conclusion strong correlation exists between CCP values obtained by means of FV and LDF during cardiac arrest. However, predictions of CCP using TCD waveform analysis show substantial differences from values of CCP recorded during cardiac arrest.

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Faculty Opinions recommendation of Association between elevated mean arterial blood pressure and neurologic outcome after resuscitation from cardiac arrest: results from a multicenter prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734212486.793557428 ◽

2019 ◽

Author(s):

Jean Charchaflieh ◽

Jill Zafar

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Cohort Study ◽

Arterial Blood Pressure ◽

Prospective Cohort Study ◽

Mean Arterial Blood Pressure ◽

Prospective Cohort ◽

Arterial Blood ◽

Multicenter Prospective Cohort Study ◽

Multicenter Prospective Cohort

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Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest

Critical Care Medicine ◽

10.1097/ccm.0000000000003474 ◽

2019 ◽

Vol 47 (1) ◽

pp. 93-100 ◽

Cited By ~ 24

Author(s):

Brian W. Roberts ◽

J. Hope Kilgannon ◽

Benton R. Hunter ◽

Michael A. Puskarich ◽

Lisa Shea ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Arterial Blood Pressure ◽

Mean Arterial Blood Pressure ◽

Neurologic Outcome ◽

Arterial Blood

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Sustained Inflation During Chest Compression: A New Technique of Pediatric Cardiopulmonary Resuscitation That Improves Recovery and Survival in a Pediatric Porcine Model

Journal of the American Heart Association ◽

10.1161/jaha.120.019136 ◽

2021 ◽

Author(s):

Georg M. Schmölzer ◽

Siddhi D. Patel ◽

Sveva Monacelli ◽

Seung Yeon Kim ◽

Gyu‐Hong Shim ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Arterial Blood Pressure ◽

Chest Compression ◽

Cerebral Oxygenation ◽

Group Versus ◽

Fold Increase ◽

Arterial Blood ◽

Sustained Inflation

Background Chest compression (CC) during sustained inflations (CC+SI) compared with CC with asynchronized ventilation (CCaV) during cardiopulmonary resuscitation in asphyxiated pediatric piglets will reduce time to return of spontaneous circulation (ROSC). Methods and Results Piglets (20–23 days of age, weighing 6.2–10.2 kg) were anesthetized, intubated, instrumented, and exposed to asphyxia. Cardiac arrest was defined as mean arterial blood pressure <25 mm Hg with bradycardia. After cardiac arrest, piglets were randomized to CC+SI (n=12) or CCaV (n=12) or sham (n=8). Sham‐operated animals had no asphyxia. Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded. There were no differences in baseline parameters or the duration and degree of asphyxiation. Median (interquartile range) Time to ROSC was 248 (41–346) seconds compared with 720 (167–720) seconds in the CC+SI group and CCaV group, respectively ( P =0.0292). There was a 100% higher rate of ROSC in the CC+SI group versus CCaV group, with 10 (83%) versus 5 (42%) achieving ROSC ( P =0.089), respectively. Piglets in the CC+SI and CCaV groups received intravenous epinephrine boluses to achieve ROSC (8/12 versus 10/12 P =0.639). There was a significantly higher minute ventilation in the CC+SI group, which was secondary to a 5‐fold increase in the number of inflations per minute and a 1.5‐fold increase in tidal volume. Conclusions CC+SI reduced time to ROSC and improved survival compared with using CCaV. CC+SI allowed passive ventilation of the lung while providing chest compressions. This technique warrants further studies to examine the potential to improve outcomes in pediatric patients with cardiac arrest. Registration URL: https://www.preclinicaltrials.eu ; Unique identifier: PCTE0000152.

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