scholarly journals Alterations in Respiratory Mechanics and Neural Respiratory Drive After Restoration of Spontaneous Circulation in a Porcine Model Subjected to Different Downtimes of Cardiac Arrest

2019 ◽  
Vol 8 (19) ◽  
Author(s):  
Zhengfei Yang ◽  
Houzhen Zheng ◽  
Lin Lin ◽  
Jingying Hou ◽  
Cai Wen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Porcine Model ◽  
Respiratory Mechanics ◽  
Spontaneous Circulation ◽  
Respiratory Drive

Humerus intraosseous administration of epinephrine in normovolemic and hypovolemic porcine model

2018 ◽  
Vol 13 (2) ◽  
pp. 97-106
Author(s):  
LTC Robert P. Long, II, PhD, CRNA ◽  
LTC Stephanie M. Gardner, DNP, CRNA ◽  
James Burgert, DNAP, CRNA ◽  
LTC Craig A. Koeller, DVM, DACLAM, AFRL ◽  
LTC Joseph O’Sullivan, PhD, CRNA ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Blood Volume ◽  
Maximum Concentration ◽  
Porcine Model ◽  
Spontaneous Circulation ◽  
Rate Of Return ◽  
Blood Samples ◽  
Return Of Spontaneous Circulation ◽  
Mean Concentration ◽  
Over Time

Objective: Compare the maximum concentration (Cmax), time to maximum concentration (Tmax), mean concentration, rate of return of spontaneous circulation (ROSC), time to ROSC, and odds of ROSC when epinephrine is administered by humerus intraosseous (HIO) compared to intravenous (IV) routes in both a hypovolemic and normovolemic cardiac arrest model.Design: Prospective, between subjects, randomized experimental study.Setting: TriService Facility.Subjects: Twenty-eight adult Yorkshire Swine were randomly assigned to four groups: HIO normovolemia; HIO hypovolemia; IV normovolemia; and IV hypovolemia.Intervention: Swine were anesthetized. The hypovolemic group was exsanguinated 31 percent of their blood volume. Subjects were placed into arrest. After 2 minutes, cardiopulmonary resuscitation (CPR) was initiated. After another 2 minutes, 1 mg epinephrine was given by IV or HIO routes; blood samples were collected over 4 minutes. Hypovolemic groups received 500 mL of 5 percent albumin following blood sampling. CPR continued until ROSC or for 30 minutes.Main outcome measures: ROSC, time to ROSC, Cmax, Tmax, mean concentrations over time, odds of ROSC.Results: Cmax was significantly higher, the Tmax, and the time to ROSC were significantly faster in the HIO normovolemic compared to the HIO hypovolemic group (p 0.05). All seven in the HIO normovolemic group achieved ROSC compared to three of the HIO hypovolemic group. Odds of ROSC were 19.2 times greater in the HIO normovolemic compared the HIO hypovolemic group.Conclusion: The HIO is an effective route in a normovolemic model. However, the findings indicate that sufficient blood volume is essential for ROSC in a hypovolemic scenario.

Abstract 16996: Controlled Pauses (“Stutter”) CPR Did Not Improve ROSC or 4-hour Survival in a Porcine Model of VF-induced Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alexander Esibov ◽  
Tyson G Taylor ◽  
Sharon B Melnick ◽  
Fred W Chapman ◽  
Gregory P Walcott
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Porcine Model ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Survival Rates ◽  
Data Gathering ◽  
Aortic Pressure ◽  
Spontaneous Circulation ◽  
Mechanical Cpr

Introduction: Ischemic post-conditioning (IPC) has shown promise in mitigating ischemia-reperfusion injury. Controlled pauses during CPR (CP-CPR) following cardiac arrest (CA) and prolonged downtime may help invoke IPC mechanisms and have been shown to improve neurological outcome in swine. We tested whether CP-CPR would improve return of spontaneous circulation (ROSC) and/or 4-hr survival rates, compared with standard CPR from a mechanical chest compression device (M-CPR), following prolonged downtime in a porcine model of ventricular fibrillation (VF)-induced CA. Methods: Twenty anesthetized and instrumented pigs were block randomized to two protocols. Following 10 min of VF, mechanical CPR was initiated (100 comp/min, 50% duty cycle, 2 inch depth). Over the first 5 minutes of CPR, the M-CPR protocol group received continuous chest compressions, while the CP-CPR protocol included four 20-sec pauses in compressions starting at 40, 100, 160, and 220 sec. All other interventions were the same in the two groups. After 5 minutes, a first shock was delivered during a pause. If the shock failed to convert to a perfusing rhythm for ≥ 30 s with a systolic aortic pressure (sAoP) ≥ 50 mmHg for at least the first three contiguous sAoP values, CPR was continued in 2 min cycles, followed by a shock (if indicated) at the end of each cycle, for up to 10 cycles. As soon as these criteria were met between two CPR cycles, ROSC was documented and a post-resuscitation protocol was initiated. During the post-resuscitation protocol, inotropic agents were provided as needed to maintain sAoP ≥ 50 mmHg. Survival was declared if the sAoP was maintained above threshold for 4 hrs following ROSC. Results: Nineteen animals were successfully instrumented for data gathering (9 CP-CPR, 10 M-CPR). In the CP-CPR and M-CPR groups respectively, 3/9 (33%) vs. 5/10 (50%) achieved ROSC (p = 0.46); when ROSC was achieved, time to ROSC was 7.7±1.2 min vs. 5.8±1.1 min (p = 0.08). All animals that achieved ROSC survived to 4 hours. Conclusions: In a porcine model of CA following prolonged VF, CP-CPR did not improve ROSC or 4-hr survival. The trend towards delayed time to ROSC suggests controlled pauses may impair initial resuscitation, even if they ultimately improve neurological outcome. Further studies are warranted.

Abstract 326: The Prediction Value of Minute Volum of Carbon Dioxide (mvco2) for Return of Spontaneous Circulation in a Porcine Model of Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Jun Xu ◽  
kui jin ◽  
Feng Sun ◽  
Yangyang Fu
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Arrest ◽  
Roc Curve ◽  
Porcine Model ◽  
Minute Ventilation ◽  
Venous Blood ◽  
Spontaneous Circulation ◽  
Minute Volume ◽  
Return Of Spontaneous Circulation ◽  
Logistic Regression Models

The prediction value of Minute Volum of Carbon dioxide (MVCO2) for return of spontaneous circulation in a porcine model of cardiac arrest Background: Parameters that can predict ROSC ramins incompletely understood. EtCO2 in prediction ROSC may be influenced by minute ventilation during CPR. Minute volume of CO2 (MVCO2) theoratically can be less affected by ventilation. The value of MVCO2 in prediction ROSC remains unknown. Objective: To investigate whether MVCO2 can predict the ROSC in porcine model and define the best cutoff value to predict failure of ROSC. Method: 15 healthy Norwegian domestic pigs received mechanical CPR 2 mins after electriclly induced VF. ETCO2, MVCO2, ALP, MAP, were recorded continuously. Arterial and central venous blood gas were tested at 5-minute after the start of resuscitation. Defbrillation was given at 6-mins after resuscitaion. Parameters were compared between animals with ROSC after difibrillation and those without. Results: 9 pigs were successfully resuscitated after defibrillation while 6 failed. There was no difference of MVCO2, ETCO2, ALP, and MAP between the two groups before induced VF. There was a correlation between MVCO2, ETCO2, ALP, and MAP values (Fig 1). Furthermore, MVCO2 was significantly lower among those animals that failed ROSC, the receiver operating characteristic (ROC) curve of MVCO2 predicte difibrillation results showed that the area under the ROC curve was 0.981. The optimal cut-off value was 123.5ml/min, with sensitivity of 97.2% and specificity of 91.7% (Fig 2). Multivariate logistic regression models suggested that MVCO2 index was an important factor affecting the prognosis of resuscitation. Summary and conclusion: This study indicates MVCO2 are highly related with ETCO2, ALP, and MAP with a better preidiction value for resuscitation prognosis than ETCO2, ALP, and MAP.

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.

365: CHANGES IN CENTRAL RESPIRATORY DRIVE OF GASPING IN A PORCINE MODEL OF CARDIAC ARREST

2016 ◽  
Vol 44 (12) ◽  
pp. 168-168
Author(s):  
Houzhen Zheng ◽  
Rui Chen ◽  
Zhengfei Yang ◽  
Wanchun Tang
Keyword(s):  
Cardiac Arrest ◽  
Porcine Model ◽  
Respiratory Drive

scholarly journals Monocyte subsets predict mortality after cardiac arrest

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.A Krychtiuk ◽  
M Lenz ◽  
B Richter ◽  
K Huber ◽  
J Wojta ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Strong Increase ◽  
Funding Source ◽  
Monocyte Subset ◽  
Male Mortality ◽  
National Budget ◽  
Classical Monocytes ◽  
Intermediate Monocytes ◽  
Subset Distribution

Abstract Background After successful cardiopulmonary resuscitation with return of spontaneous circulation (ROSC), many patients show signs of an overactive immune activation. Monocytes are a heterogenous cell population that can be distinguished into three subsets. Purpose The aim of this prospective, observational study was to analyze whether monocyte subset distribution is associated with mortality at 6 months in patients after cardiac arrest. Methods We included 53 patients admitted to our medical ICU after cardiac arrest. Blood was taken on admission and monocyte subset distribution was analyzed by flow cytometry and distinguished into classical monocytes (CM; CD14++CD16-), intermediate monocytes (IM; CD14++CD16+CCR2+) and non-classical monocytes (NCM; CD14+CD16++CCR2-). Results Median age was 64.5 (IQR 49.8–74.3) years and 75.5% of patients were male. Mortality at 6 months was 50.9% and survival with good neurological outcome was 37.7%. Of interest, monocyte subset distribution upon admission to the ICU did not differ according to survival. However, patients that died within 6 months showed a strong increase in the pro-inflammatory subset of intermediate monocytes (8.3% (3.8–14.6)% vs. 4.1% (1.5–8.2)%; p=0.025), and a decrease of classical monocytes (87.5% (79.9–89.0)% vs. 90.8% (85.9–92.7)%; p=0.036) 72 hours after admission. In addition, intermediate monocytes were predictive of outcome independent of initial rhythm and time to ROSC and correlated with the CPC-score at 6 months (R=0.32; p=0.043). Discussion Monocyte subset distribution is associated with outcome in patients surviving a cardiac arrest. This suggests that activation of the innate immune system may play a significant role in patient outcome after cardiac arrest. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): FWF - Fonds zur Förderung der wissenschaftlichen Forschung

Loperamide Induced Recurrent Torsades de Pointes: A Case Report

2021 ◽  
pp. 089719002110048
Author(s):  
Gregory G. Jackson ◽  
Christine R. Lopez ◽  
Elizabeth S. Bermudez ◽  
Nina E. Hill ◽  
Dan M. Roden ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Torsades De Pointes ◽  
Altered Mental Status ◽  
Spontaneous Circulation ◽  
Prior History ◽  
Common Phenomenon ◽  
Medical Providers ◽  
Return Of Spontaneous Circulation ◽  
History Of ◽  
Overdrive Pacing

Purpose: A case of loperamide-induced recurrent torsades de pointes is reported to raise awareness of an increasingly common phenomenon that could be encountered by medical providers during the current opioid epidemic. Summary: A 40 year-old-man with a prior history of opioid abuse who presented to the emergency department after taking up to 100 tablets of loperamide 2 mg daily for 5 years to blunt opioid withdrawal symptoms and was subsequently admitted to the intensive care unit for altered mental status and hyperthermia. The patient had prolonged QTc and 2 episodes of torsades de pointes (TdP) that resulted in cardiac arrest with return of spontaneous circulation. He was managed with isoproterenol, overdrive pacing, and methylnatrexone with no other events of TdP or cardiac arrest. Conclusion: A 40-year-old male who developed torsades de pointes from loperamide overdose effectively treated with overdrive pacing, isoproterenol, and methylnatrexone.

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