scholarly journals Even Four Minutes of Poor Quality of CPR Compromises Outcome in a Porcine Model of Prolonged Cardiac Arrest

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Heng Li ◽  
Lei Zhang ◽  
Zhengfei Yang ◽  
Zitong Huang ◽  
Bihua Chen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Porcine Model ◽  
Coronary Perfusion Pressure ◽  
Poor Quality ◽  
Spontaneous Circulation ◽  
Coronary Perfusion ◽  
Chest Compressions ◽  
Yorkshire Pigs ◽  
Anterior Posterior

Objective. Untrained bystanders usually delivered suboptimal chest compression to victims who suffered from cardiac arrest in out-of-hospital settings. We therefore investigated the hemodynamics and resuscitation outcome of initial suboptimal quality of chest compressions compared to the optimal ones in a porcine model of cardiac arrest.Methods. Fourteen Yorkshire pigs weighted 30 ± 2 kg were randomized into good and poor cardiopulmonary resuscitation (CPR) groups. Ventricular fibrillation was electrically induced and untreated for 6 mins. In good CPR group, animals received high quality manual chest compressions according to the Guidelines (25% of animal’s anterior-posterior thoracic diameter) during first two minutes of CPR compared with poor (70% of the optimal depth) compressions. After that, a 120-J biphasic shock was delivered. If the animal did not acquire return of spontaneous circulation, another 2 mins of CPR and shock followed. Four minutes later, both groups received optimal CPR until total 10 mins of CPR has been finished.Results. All seven animals in good CPR group were resuscitated compared with only two in poor CPR group (P<0.05). The delayed optimal compressions which followed 4 mins of suboptimal compressions failed to increase the lower coronary perfusion pressure of five non-survival animals in poor CPR group.Conclusions. In a porcine model of prolonged cardiac arrest, even four minutes of initial poor quality of CPR compromises the hemodynamics and survival outcome.

Abstract 167: Epinephrine Plus Chest Compressions May Be Superior to Epinephrine Alone in a Hypoxia-Induced Porcine Model of Lifeless Shock

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Felipe Teran ◽  
Claire Centeno ◽  
Alex L Lindqwister ◽  
William J Hunckler ◽  
William Landis ◽  
...  
Keyword(s):  
Chest Compression ◽  
Porcine Model ◽  
Contractile Activity ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Swine Model ◽  
Coronary Perfusion ◽  
Chest Compressions ◽  
Fraction Of Inspired Oxygen ◽  
External Chest Compressions

Background: Lifeless shock (LS) (previously called EMD and pseudo-PEA) is a global hypotensive ischemic state with retained coordinated myocardial contractile activity and an organized ECG. We have previously described our hypoxic LS model. The role of standard external chest compressions remains unclear in the setting of LS and its associated intrinsic hemodynamics. Although it is known the patients with LS have better prognosis compared to PEA, it is unclear what is the best treatment strategy. Prior work has shown that chest compressions (CC) when synchronized with native systole results in significant hemodynamic improvement, most notably coronary perfusion pressure (CPP), and hence it is plausible that standard dyssynchronous CC may be detrimental to hemodynamics. Furthermore, retrospective clinical data has shown that LS patients treated with vasopressors and no CC, may have better outcomes. We compared epinephrine only versus epinephrine and chest compression, in a porcine model of LS. Methods: Our porcine model of hypoxic LS has previously been described. We randomized pigs to episodes of LS treated with epinephrine only (control) (0.0015 mg/kg) versus epinephrine plus standard external chest compressions (intervention). Animals were endotracheally intubated and mechanically ventilated, and the fraction of inspired oxygen (FiO 2 ) was gradually lowered from room air (20-30% O 2 ) to a target FiO 2 of 3-7% O 2 . This target FiO 2 was maintained until the systolic blood pressure (SBP) dropped to 30 mmHg for 30 seconds, or the animal became bradycardic (HR less than 40), which was defined as the start of LS. FiO 2 was then raised to 100%, and then animal would receive control or intervention. Return of spontaneous circulation (ROSC) was defined as SBP 60 mmHg, stable after 2 minutes. Results: Twenty-six episodes of LS in 11 animals received epinephrine only control and 21 episodes the epinephrine plus chest compression intervention. The rates of ROSC in two minutes or less were 5/26 (19%) in the control arm vs 14/21 (67%) in the intervention arm (P=0.001;95% CI 19.7 %-67.2%). Conclusions: In a swine model of hypoxia induced LS, epinephrine plus CPR may be superior to epinephrine alone.

Cardiac Arrest and Resuscitation

2015 ◽  
Author(s):  
Charles N. Pozner ◽  
Jennifer L Martindale
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Arrhythmias ◽  
Perfusion Pressure ◽  
Pulseless Electrical Activity ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Coronary Perfusion ◽  
Chest Compressions ◽  
Cardiac Resuscitation ◽  
Neurologic Function

The most effective treatment for cardiac arrest is the administration of high-quality chest compressions and early defibrillation; once spontaneous circulation is restored, post–cardiac arrest care is essential to support full return of neurologic function. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of cardiac arrest and resuscitation. Figures show the foundations of cardiac resuscitation, ventricular arrhythmias, coronary perfusion pressure as a function of time, an algorithm for initial treatment of cardiac arrest, sample capnographs, and the electrocardiographic appearance of varying degrees of hyperkalemia. Tables include components of suboptimal cardiac resuscitation and corrective actions, recommended doses of medications commonly used in cardiac resuscitation, causes of pulseless electrical activity/asystolic arrest to consider, immediate post–return of spontaneous circulation checklist, and resuscitation goals during post–cardiac arrest care. This review contains 6 highly rendered figures, 5 tables, and 142 references.

Cardiac massage and blood flow management during cardiac arrest

2016 ◽  
Author(s):  
Gavin D. Perkins
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Essential Element ◽  
Coronary Perfusion Pressure ◽  
Cardiac Massage ◽  
Coronary Perfusion ◽  
Chest Compressions ◽  
Term Survival

When cardiac arrest occurs, blood flow to the vital organs diminishes rapidly. Chest compressions are an essential element of cardiopulmonary resuscitation (CPR), yet they achieve, at best, one-third of the normal cardiac output. The speed of initiating CPR, as well as its quality is critical to patient outcomes. Optimal chest characteristics of compressions are defined as pushing hard (depth > 5 cm) and fast (compression rate 100–120/min). Pressure should be released fully between sequential chest compressions and interruptions in chest compressions should be minimized. Even short interruptions in CPR around the time of attempted defibrillation can be harmful. CPR feedback and prompt devices can be used to monitor the quality of CPR. Studies have shown these devices can improve the quality of CPR, but do not improve overall survival. Mechanical chest compression devices may be usefully deployed when it is difficult or unsafe to perform manual CPR, but there is no evidence that the routine deployment of these devices improves outcome. Vasoactive drugs improve coronary perfusion pressure and increase the chances of return of spontaneous circulation. However, there is no definitive evidence that they improve long-term survival. Recent data have raised the possibility that adrenaline may worsen long-term outcomes.

Abstract 254: Synchronized Chest Compressions for Pseudo-PEA: Proof of Concept and Synching Algorithm

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Keith Marill ◽  
James J Menegazzi ◽  
Allison C Koller ◽  
Matthew Sundermann ◽  
David D Salcido
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Porcine Model ◽  
Pulseless Electrical Activity ◽  
Compression Therapy ◽  
Coronary Perfusion Pressure ◽  
Coronary Perfusion ◽  
Compression Rate ◽  
Proof Of Concept ◽  
Chest Compressions

Introduction: Pulseless electrical activity (PEA) is a common rhythm in cardiac arrest with a persistently poor outcome. This report describes our successful development of a synchronized compression device and algorithm to treat PEA with or without intrinsic myocardial contractions. Methods: We adapted our previously developed signal-guided CPR system to provide synchronized compressions in a porcine model of cardiac arrest. We describe the first comparison of unsynchronized to synchronized compressions in a single animal as a proof-of-concept. We developed an algorithm to provide optimal synchronized chest compressions regardless of intrinsic heartrate while simultaneously maintaining the chest compression rate within a desired range. We tested the algorithm with computer simulations measuring the proportion of intrinsic and compression beats that were synchronized, and the compression rate and its standard deviation, as a function of intrinsic heartrate and heartrate jitter. Results: We demonstrate and compare unsynchronized versus synchronized chest compressions in a single porcine model with an intrinsic rhythm and hypotension. Synchronized, but not unsynchronized, chest compressions were associated with increased blood pressure and coronary perfusion pressure (Figure). Our synchronized chest compression algorithm is able to provide synchronized chest compressions to over 90% of intrinsic beats for most heartrates while maintaining an average compression rate between 95 and 135 BPM with relatively low variability. Conclusion: Synchronized chest compression therapy for pulseless electrical rhythms is feasible. A high degree of synchronization can be maintained over a broad range of intrinsic heart rates while maintaining the compression rate within a satisfactory range. Further investigation to assess benefit for treatment of PEA is warranted.

Abstract 434: A Randomized Blinded Trial of Three Chest Compression Strategies in a Porcine Model of Pediatric Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
James J Menegazzi ◽  
David D Salcido ◽  
Allison C Koller ◽  
Cornelia Genbrugge ◽  
Ericka L Fink ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Lung Injury ◽  
Chest Compression ◽  
Porcine Model ◽  
Lung Injury Score ◽  
Coronary Perfusion ◽  
Chest Compressions ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Current guidelines recommend that chest compressions for children be done at either 1.5 inches depth and 100 per minute, or one-third the chest A-P diameter depth and 100 per minute. Neither of these recommendations is based on scientific evidence. Objective: As part of an ongoing efficacy trial, we sought to compare the safety of three different chest compression strategies in a porcine model of pediatric cardiac arrest. Methods: Following anesthesia, instrumentation, and induction of asphyxial cardiac arrest, we randomly assigned 48 domestic swine to one of three groups (n=16 per group). The mean mass of 25.7 kg approximates the 50 th percentile for a 7 year old. Group 1 had fixed chest compression depth of 1.5 inches/rate 100; group 2 had fixed proportional depth of one-third the A-P diameter/rate 100; group 3 used an adaptive algorithm that incrementally increased chest compression rate and/or depth from baseline 1.5in (max: 2.13in) and 100/min (max; 130/min) every 25s while coronary perfusion pressure was below 25mmHg. Necropsies were independently performed by a veterinarian and veterinary technologist who were blinded to group assignment. The primary safety outcome was unrecoverable injury (i.e. toxicity), which we defined as either a total lung injury score ≥16 (score can range from 0 to 20) plus presence of hemothorax, or disruption of either the aorta or vena cava. Data were analyzed with the Bayesian Beta Binomial to determine if within-group toxicity exceeded an unacceptable level (30%) with a pre-selected posterior predictive threshold of 0.75(ptox). Lung injury scores between groups were compared with Kruskal-Wallis tests. Results: Median total lung injury scores were: 12 for group 1; 18 for group 2; 14 for group 3. Group 2 was significantly different from both groups 1 and 3 (p<0.001). Groups 1 and 3 did not differ (p=0.24). Toxicity occurred in zero animals in group 1 (ptox=0.0001); 7 animals in group 2 (ptox=0.8180); and 1 animal in group 3 (ptox=0.0076). The posterior probability threshold was exceeded in group 2 which warranted termination of the treatment arm for safety. Conclusions: Chest compressions performed at a depth of one-third the A-P diameter are unsafe. The safety of this approach in children should be carefully evaluated.

scholarly journals Comparing anesthesia with isoflurane and fentanyl/fluanisone/midazolam in a rat model of cardiac arrest

2017 ◽  
Vol 123 (4) ◽  
pp. 867-875 ◽  
Author(s):  
Niels Secher ◽  
Christian Lind Malte ◽  
Else Tønnesen ◽  
Leif Østergaard ◽  
Asger Granfeldt
Keyword(s):  
Cardiac Arrest ◽  
Reperfusion Injury ◽  
Perfusion Pressure ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Coronary Perfusion ◽  
Return Of Spontaneous Circulation ◽  
Arterial Blood

Only one in ten patients survives cardiac arrest (CA), underscoring the need to improve CA management. Isoflurane has shown cardio- and neuroprotective effects in animal models of ischemia-reperfusion injury. Therefore, the beneficial effect of isoflurane should be tested in an experimental CA model. We hypothesize that isoflurane anesthesia improves short-term outcome following resuscitation from CA compared with a subcutaneous fentanyl/fluanisone/midazolam anesthesia. Male Sprague-Dawley rats were randomized to anesthesia with isoflurane ( n = 11) or fentanyl/fluanisone/midazolam ( n = 11). After 10 min of asphyxial CA, animals were resuscitated by mechanical chest compressions, ventilations, and epinephrine and observed for 30 min. Hemodynamics, including coronary perfusion pressure, systemic O2 consumption, and arterial blood gases, were recorded throughout the study. Plasma samples for endothelin-1 and cathecolamines were drawn before and after CA. Compared with fentanyl/fluanisone/midazolam anesthesia, isoflurane resulted in a shorter time to return of spontaneous circulation (ROSC), less use of epinephrine, increased coronary perfusion pressure during cardiopulmonary resusitation, higher mean arterial pressure post-ROSC, increased plasma levels of endothelin-1, and decreased levels of epinephrine. The choice of anesthesia did not affect ROSC rate or systemic O2 consumption. Isoflurane reduces time to ROSC, increases coronary perfusion pressure, and improves hemodynamic function, all of which are important parameters in CA models. NEW & NOTEWORTHY The preconditioning effect of volatile anesthetics in studies of ischemia-reperfusion injury has been demonstrated in several studies. This study shows the importance of anesthesia in experimental cardiac arrest studies as isoflurane raised coronary perfusion pressure during resuscitation, reduced time to return of spontaneous circulation, and increased arterial blood pressure in the post-cardiac arrest period. These effects on key outcome measures in cardiac arrest research are important in the interpretation of results from animal studies.

Abstract 1804: Is CPR Quality Improving? A Retrospective Study Of Out-of-hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Theresa M Olasveengen ◽  
Lars Wik ◽  
Jo Kramer-Johansen ◽  
Kjetil Sunde ◽  
Morten Pytte ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Scientific Evidence ◽  
Spontaneous Circulation ◽  
Quality Analysis ◽  
Medical Systems ◽  
Chest Compressions ◽  
Chi Square ◽  
Transthoracic Impedance ◽  
Cpr Quality

Aim of the study: To evaluate quality of cardiopulmonary resuscitation (CPR) performed by a physician-manned ambulance, and assess whether it changed with time influenced by developing scientific evidence and guideline changes. Materials and methods: Retrospective, observational study of all cardiac arrest patients (except trauma) older than 18 years treated between May 2003 and December 2006 by the physician-manned ambulance in Oslo. CPR quality was assessed from continuous electronic recordings from the defibrillators (LIFEPAK 12, Physio-Control or a modified Heartstart 4000, Philips Medical Systems). Ventilations were assessed from changes in transthoracic impedance, chest compressions from transthoracic impedance for LIFEPAK 12 and from an accelerometer for Heartstart 4000 (nine patients). Values are given as mean ± SD and differences analysed with ANOVA and unpaired Student’s t-test with Bonferroni correction. Results: Forty-eight of 169 consecutive cases were excluded from CPR quality analysis, 47 due to missing defibrillator data and one due to short arrest time (<1 min). Hands-off intervals (fraction of time without spontaneous circulation where no chest compressions are given) were reduced from 0.18±0.11 in 2003 to 0.10±0.06 in 2006 (p=0.03). Compression and ventilation rates were significantly reduced from 122±12 and 16±3 per minute respectively in 2003 to 111±10 and 12±3 in 2006 (p<0.0001 and p=0.001). In 2003–4 10% were discharged alive vs. 16 % in 2005–6 (p=0.3, Chi square test). Conclusion: High quality CPR is achievable out-of-hospital, and the improvement with time could reflect developing scientific evidence focusing on reducing hands-off intervals and hyperventilation. Quality of CPR from May 2003 to 2006.

Endobronchial Vasopressin Improves Survival during Cardiopulmonary Resuscitation in Pigs 

1997 ◽  
Vol 86 (6) ◽  
pp. 1375-1381 ◽  
Author(s):  
Volker Wenzel ◽  
Karl H. Lindner ◽  
Andreas W. Prengel ◽  
Keith G. Lurie ◽  
Hans U. Strohmenger
Keyword(s):  
Placebo Group ◽  
Cardiopulmonary Resuscitation ◽  
Drug Administration ◽  
Porcine Model ◽  
Perfusion Pressure ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Coronary Perfusion ◽  
Successful Resuscitation ◽  
Short Period

Background Intravenous administration of vasopressin during cardiopulmonary resuscitation (CPR) has been shown to be more effective than optimal doses of epinephrine. This study evaluated the effect of endobronchial vasopressin during CPR. Methods After 4 min of untreated ventricular fibrillation and 3 min of CPR, 21 pigs were randomized to be treated with 0.8 U/kg intravenous vasopressin (n = 7), 0.8 U/kg endobronchial vasopressin (n = 9), or an endobronchial placebo of normal saline (n = 5). Defibrillation was performed 5 min after drug administration to attempt return of spontaneous circulation. Results All animals in the intravenous and endobronchial vasopressin group were resuscitated successfully, but only two of five animals in the placebo group were. At 2 and 5 min after drug administration, coronary perfusion pressure in the intravenous and endobronchial vasopressin group was significantly higher than in the placebo group (50 +/- 10, 34 +/- 5 vs. 16 +/- 6 mmHg, respectively; and 35 +/- 10, 39 +/- 10 vs. 19 +/- 5 mmHg, respectively; P &lt; 0.05). Conclusions Endobronchial vasopressin is absorbed during CPR, coronary perfusion pressure is increased significantly within a short period, and the chance of successful resuscitation is increased in this porcine model of CPR. Endobronchial vasopressin may be an alternative for vasopressor administration during CPR, when intravenous access is delayed or not available.

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