The effect of chest compression depth on short term survival during out of hospital cardiac arrest

Statins (HMG-CoA reductase inhibitors) exert numerous pleiotropic effects and have been shown to attenuate ischemic injury in different rodent models of cerebral focal ischemia. Few studies have examined the effect of statins on post cardiac arrest syndrome. This study conducted cardiac arrest and cardiopulmonary resuscitation (CA/CPR) in mice and tested the hypothesis that intravenous statin after CPR improves survival rate and neurological outcomes. Methods: Adult male mice (20-26 g) were subjected to CA induced by intravenous (IV) KCL. After 8 min of CA, CPR was initiated with IV epinephrine, ventilation with 100% oxygen and chest compressions (rate 300/min). At 1 hr after return of spontaneous circulation, mice were treated with either IV injection of pravastatin (3mg/kg) or vehicle. Four days after CA/CPR, neurobehavioral assessments were performed and brains were removed for histological evaluation in hippocampus and caudateputamen. Results: No difference was found between two groups in body weight, duration of CPR and dose of epinephrine. Survival rate at 4 days after CPR was significantly higher in pravastatin group compared with vehicle group (66.7%; n=24 vs 48.4%; n=33). Neurobehavioral scores in pravastatin group were better than vehicle group at 2 to 4 days after CPR. Body weight loss in vehicle group at 4 days after CPR was higher than pravastatin group (-19.4±1.8% vs -13.4±2.0%), which indicates loss of feeding activity. Histological damages in hippocampus and caudateputamen were not statistically different between two groups (pravastatin: 23.8±7.0% vs vehicle: 35.2±9.2% in hippocampus) (pravastatin: 49.4±7.2% vs vehicle: 60.5±7.8% in caudateputamen). All values are presented as mean±SEM. Conclusions: Single IV injection of pravastatin after CA improved short-term survival and neurobehavioral score in the mouse experimental CA model. Neuronal damage in the brain region was comparable to vehicle group. These data suggest that pravastatin given after CA would be beneficial in the post resuscitation phase via systemic pleiotropic effects such as anti inflammatory response and improved vascular reactivity.

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Abstract 9056: The Association Between Thoracic Injuries Due to Chest Compression and Short-Term Prognosis in Patients With Non-traumatic Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.9056 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Aya Katasako ◽

Shoji Kawakami ◽

Hidenobu Koga ◽

Kenichi Kitahara ◽

Keiichiro Komiya ◽

...

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Survival Rates ◽

Area Under The Curve ◽

Spontaneous Circulation ◽

Rank Test ◽

Thoracic Injuries ◽

Short Term ◽

Roc Curve Analysis ◽

Hospital Cardiac Arrest

Background: The current guidelines emphasize that high-quality chest compression is essential for improving the survival in out-of-hospital cardiac arrest (OHCA) patients. However, it may lead to thoracic injuries which is a potential factor of poor prognosis. Method: Between June 2017 to July 2019, we collected Utstein-style data on 384 consecutive adult patients with non-traumatic OHCA who were transferred to our hospital. Full-body CT scan was performed and thoracic injuries were defined as rib fracture, sternum fracture, hemorrhagic pleural effusion, pneumothorax, sternum posterior bleeding, mediastinal hematoma, or mediastinal emphysema. We identified the predictors for thoracic injuries and evaluated the relationship between thoracic injuries and prognosis. Results: Patients with thoracic injuries (Group-T) were 234 (76%). The duration of chest compression in Group-T was 43 min, which was significantly longer than that in patients without thoracic injuries (Group-N, 32 min, p<0.001). ROC curve analysis identified a duration of chest compression of 35 minutes as the optimal cut off for predicting thoracic injuries (area under the curve 0.73). Multivariate analysis revealed that age (OR: 1.03, 95%CI: 1.01-1.05, p=0.005) and duration of chest compression (OR: 1.07, 95%CI: 1.04-1.09, p<0.001) were independent predictors of thoracic injuries. The rate of obtaining return of spontaneous circulation (ROSC), 30-day survival and favorable neurologic outcome were larger in Group-N than Group-T. In patients with achieving ROSC, Kaplan-Meier curves showed a significantly higher cumulative survival rates in Group-N compared to that in Group-T during follow-up of 30 days (Log-rank test p=0.009). Conclusion: Age and duration of chest compression were independent predictors for thoracic injuries due to chest compression in non-traumatic OHCA patients. Moreover, the presence of thoracic injuries was associated with poor short-term prognosis.

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Abstract 324: Assessment of Optimal Chest Compression Depth to Optimize Cardiopulmonary Resuscitation: A Randomized Controlled Trial

Circulation ◽

10.1161/circ.142.suppl_4.324 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Marlies Bruckner ◽

Seung Yeun Kim ◽

Gyu Hong Shim ◽

Mattias Neset ◽

Po-yin Cheung ◽

...

Keyword(s):

Chest Compression ◽

Controlled Trial ◽

Minute Ventilation ◽

Venous Pressure ◽

Term Survival ◽

Compression Depth ◽

Neonatal Piglets ◽

Respiratory Parameters ◽

Anterior Posterior ◽

Short Term Survival

Introduction: Neonatal chest compression (CC) should be performed to a 1/3 anterior-posterior (AP) chest diameter depth, however, the optimal AP depth is unknown. Hypothesis: We hypothesized that in asphyxiated neonatal piglets a 40% AP depth compared to 1/3, or 1/4 AP depth will reduce time to achieve return of spontaneously circulation and improve survival. Methods: Newborn piglets (n=8/group) were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by asphyxia and cardiac arrest. Piglets were randomly allocated to four intervention groups (“AP 12.5% depth”, “AP 1/4 depth”, “AP 1/3 depth” or “AP 40% depth“). CCs were performed using an automated CC machine with a rate of 90/min. Hemodynamic and respiratory parameters were continuously measured. Results: Median (IQR) time to return of spontaneously circulation was 70 (60-117), 85 (72-90), 90 (90-130), and 600 (600-600) sec with AP 40% depth, AP 1/3 depth, AP 1/4 depth, AP 12.5% depth, respectively. No piglet in the AP 12.5% depth group achieved ROSC while the short-term survival (1h) in the other groups was 100%. Systolic and diastolic blood pressure, central venous pressure, carotid blood flow, tidal volume, and minute ventilation increased with increasing AP depth. Conclusions: Time to return of spontaneously circulation and survival was similar between 1/4, 1/3, and 40% AP depth, while 12.5% AP depth did not result in return of spontaneously circulation. Hemodynamic and respiratory parameters improved with increasing AP depth suggesting that 40% AP depth might provide improved organ perfusion and oxygen delivery.

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