Cardiopulmonary resuscitation in a swine model of cardiac arrest

Introduction: Cardiac arrest (CA) is a daunting medical emergency. In order to answer various questions regarding CA, and furthermore to implement novel therapeutic strategies, various animal models have been used.Aim: The aim of the present study is to describe the experimental model of CA and cardiopulmonary resuscitation (CPR), developed in our department.Materials and methods: Twenty pigs were anaesthetized and intubated. The internal jugular veins were surgically prepared, together with the carotid artery. Ventricular fibrillation (VF) was induced with an ordinary lithium battery through a pacing wire inserted into the right ventricle. The animals were resuscitated with the 2005 advanced life support algorythm (ALS), as proposed by International organizations. If the animals restored spontaneous circulation, they were further monitored for 30 minutes.Results: Nine animals restored spontaneous circulation with the implementation of the aforementioned protocol. Successful resuscitation was associated with the coronary perfusion pressure and PETCQ2 during external cardiac compressions.Conclusions: The use of an ordinary lithium battery is a safe and efficient way to induce CA. Swine baseline hemodynamics closely resemble those of human, making the swine model, a favorable model for experimental CA-induction and CPR.

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Cardiopulmonary arrest and resuscitation in Landrace/Large White swine: a research model

Laboratory Animals ◽

10.1258/002367707781282820 ◽

2007 ◽

Vol 41 (3) ◽

pp. 353-362 ◽

Cited By ~ 36

Author(s):

T Xanthos ◽

P Lelovas ◽

I Vlachos ◽

N Tsirikos-Karapanos ◽

E Kouskouni ◽

...

Keyword(s):

Cardiac Arrest ◽

Lithium Battery ◽

Life Support ◽

Cardiopulmonary Arrest ◽

Advanced Life Support ◽

Coronary Perfusion Pressure ◽

Coronary Perfusion ◽

Large White ◽

Jugular Veins ◽

Successful Resuscitation

Sudden cardiac death (SCD) is a field of continuous research. In order to answer various questions regarding SCD, several animal models have been developed. The aim of the present study is to describe our experimental model of inducing cardiac arrest in Landrace/Large White pigs, and then resuscitated according to the International Guidelines on resuscitation. Fifteen Landrace/Large White pigs were anaesthetized and intubated while spontaneously breathing. The left and right jugular veins, as well as the femoral and the carotid arteries, were surgically prepared. Induction of cardiac arrest was achieved by using an ordinary rechargeable lithium battery, through a pacemaker wire inserted into the right ventricle. The typical Advanced Life Support (ALS) protocol was followed, and in case of restoration of spontaneous circulation, the animals were further evaluated for 30 min. Seven animals were successfully resuscitated using this protocol, whereas eight failed resuscitation efforts. Successful resuscitation was contingent on the restoration of the levels of coronary perfusion pressure and PETCO2 during chest compressions. Among the different ways of inducing cardiac arrest, the ordinary lithium battery is a simple, safe and valuable technique. Landrace/Large White pigs' baseline haemodynamics closely resemble human haemodynamics, making the breed a favourable model for resuscitation.

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Swine model in cardiopulmonary resuscitation research

Journal of the Hellenic Veterinary Medical Society ◽

10.12681/jhvms.14935 ◽

2017 ◽

Vol 60 (3) ◽

pp. 254

Author(s):

Th. XANTHOS (Θ. ΞΑΝΘΟΣ)

Keyword(s):

Cardiac Arrest ◽

Perfusion Pressure ◽

Coronary Perfusion Pressure ◽

Spontaneous Circulation ◽

Experimental Models ◽

Medical Emergency ◽

Swine Model ◽

Coronary Perfusion ◽

Anatomy And Physiology ◽

Experimental Treatments

Cardiac Arrest (CA) constitutes a real medical emergency. Various experimental models have been developed in order to test experimental treatments. Animal models that have been used in CA research are rodents, rabbits, cats and dogs, primates and swine. Among these, swine are used more often. The reason behind this choice is mostly its close resemblance to the human cardiac anatomy and physiology. Various haemodynamic variables have been investigated as predictors of the return of spontaneous circulation (ROSC). Coronary Perfusion Pressure (CPP) is the only proven predictor for ROSC. CPP, which is responsible for myocardial perfusion, greatly augments during chest compressions. ROSC and therefore survival after CA has been associated with CCP values greater than 15 mmHg for humans and 25 mmHg for animals. For the experimental induction of CA various electric sources have been used. All these experimental devices could be potentially dangerous for researchers, even though, no incidence of electrocution has been reported in the international literature. The ordinary cadmium battery appears to be safer and is an extremely effective way of inducing cardiac arrest.

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Non-invasive diffuse optical neuromonitoring during cardiopulmonary resuscitation predicts return of spontaneous circulation

Scientific Reports ◽

10.1038/s41598-021-83270-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tiffany S. Ko ◽

Constantine D. Mavroudis ◽

Ryan W. Morgan ◽

Wesley B. Baker ◽

Alexandra M. Marquez ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hemoglobin Concentration ◽

Spontaneous Circulation ◽

Youden Index ◽

Swine Model ◽

Return Of Spontaneous Circulation ◽

Non Invasive ◽

Tissue Optical Properties ◽

Tenfold Cross Validation

AbstractNeurologic injury is a leading cause of morbidity and mortality following pediatric cardiac arrest. In this study, we assess the feasibility of quantitative, non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) neuromonitoring during cardiopulmonary resuscitation (CPR), and its predictive utility for return of spontaneous circulation (ROSC) in an established pediatric swine model of cardiac arrest. Cerebral tissue optical properties, oxy- and deoxy-hemoglobin concentration ([HbO2], [Hb]), oxygen saturation (StO2) and total hemoglobin concentration (THC) were measured by a FD-DOS probe placed on the forehead in 1-month-old swine (8–11 kg; n = 52) during seven minutes of asphyxiation followed by twenty minutes of CPR. ROSC prediction and time-dependent performance of prediction throughout early CPR (< 10 min), were assessed by the weighted Youden index (Jw, w = 0.1) with tenfold cross-validation. FD-DOS CPR data was successfully acquired in 48/52 animals; 37/48 achieved ROSC. Changes in scattering coefficient (785 nm), [HbO2], StO2 and THC from baseline were significantly different in ROSC versus No-ROSC subjects (p < 0.01) after 10 min of CPR. Change in [HbO2] of + 1.3 µmol/L from 1-min of CPR achieved the highest weighted Youden index (0.96) for ROSC prediction. We demonstrate feasibility of quantitative, non-invasive FD-DOS neuromonitoring, and stable, specific, early ROSC prediction from the third minute of CPR.

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Management of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620925681 ◽

2020 ◽

Vol 9 (4_suppl) ◽

pp. S82-S89

Author(s):

Michael Poppe ◽

Mario Krammel ◽

Christian Clodi ◽

Christoph Schriefl ◽

Alexandra-Maria Warenits ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Emergency Medical Services ◽

Life Support ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Medical Services ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Emergency Medical ◽

Hospital Cardiac Arrest

Objective Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. Methods All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Results Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96). Conclusion An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.

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Out-of-Hospital Cardiac Arrest Response to a Pregnant Woman by the 119 Emergency Medical Service System: A Case Study

Fire science and engineering ◽

10.7731/kifse.2020.34.1.127 ◽

2020 ◽

Vol 34 (1) ◽

pp. 127-134

Author(s):

Jae-Min Lee ◽

Soo-Mi Hong ◽

Guk-Ki An ◽

Hyeong-Wan Yun

Keyword(s):

Cardiac Arrest ◽

Pregnant Woman ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Pregnant Patient ◽

Advanced Cardiac Life Support ◽

Spontaneous Circulation ◽

Emergency Medical Service System ◽

Rescue Workers ◽

System A

When a pregnant woman experiences cardiac arrest, resuscitation is of the utmost importance. Cardiac arrest in pregnant women differs from cardiac arrest in the general population since both mother and fetus need to be taken into consideration. In the event of cardiac arrest, determining whether to deliver the baby is significant. Cardiopulmonary resuscitation is not always successful, and the survival rate depends on the speed and precision of the procedure. In this study, we focus on the case of a 30-year-old pregnant woman who experienced cardiac arrest and whose family was quick to perceive her condition and call the hospital. A witness performed initial cardiopulmonary resuscitation, while rescue workers performed the advanced procedure. In this case, the patient and baby received proper treatment and left the hospital after six days. It is extremely rare for a pregnant patient to achieve return of spontaneous circulation (ROSC) or receive advanced cardiac life support before reaching the hospital. However, the woman in question in this study achieved ROSC and received both cardiopulmonary resuscitation before reaching the hospital and advanced cardiac life support at the hospital. The specifics of the case are reported in the context of a literature review.

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Abstract 268: Evaluation of the Abdominal Aortic and Junctional Tourniquet as an Adjunct to Chest Compressions in a Swine Model of Out-Of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.268 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Jason Rall ◽

Chris Hewitt ◽

Matthew Pombo ◽

Maria Castaneda ◽

Perry Blough

Keyword(s):

Cardiac Arrest ◽

Repeated Measures ◽

Life Support ◽

Diastolic Pressure ◽

Laboratory Animals ◽

Swine Model ◽

Coronary Perfusion ◽

Chest Compressions ◽

Abdominal Aortic ◽

Hospital Cardiac Arrest

Introduction: Overall success in treating out-of-hospital cardiac arrest using traditional chest compressions is low. The abdominal aortic and junctional tourniquet (AAJT) is a device with a wedge-shaped air bladder that can be used to occlude the descending aorta at the level of bifurcation. In addition to shunting blood away from the lower extremities, this device may increase pleural pressures by inhibiting movement of the diaphragm during compressions. We have previously shown that the addition of an AAJT to mechanical chest compression leads to an increase in rate of survival in a model of traumatic cardiac arrest. Hypothesis: This study was designed to determine if application of the AAJT would lead to more effective chest compressions as measured by an increased rate of return of spontaneous circulation (ROSC) and hemodynamic parameters. Methods: Yorkshire swine (n=6 per group) underwent general anesthesia and instrumentation. Ventricular fibrillation was electrically induced using spinal needles placed in contact with the left ventricle. After eight minutes of arrest, chest compressions were initiated. Animals were then allocated into groups with or without the AAJT. Following a total of ten minutes of compressions, the animals entered into a ten-minute advanced cardiac life support phase. Results: A ROSC was not achieved in either group. No significant differences were observed with coronary perfusion pressure or end tidal CO 2 . However, the AAJT group had a significantly higher carotid diastolic pressure and higher blood flow in the carotid as compared with repeated-measures ANOVA (p = 0.016 and 0.028 respectively). Conclusion: The AAJT did not confer a survival advantage during chest compressions in our swine model of cardiac arrest. However, while the AAJT was in place, improvement was observed in some measures of CPR efficacy. Disclaimer: The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components. The experiments reported herein were conducted according to the principles set forth in the National Institute of Health Publication No. 80-23, Guide for the Care and Use of Laboratory Animals and the Animal Welfare Act of 1966, as amended.

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Abstract 19: Effects of Stomach Inflation on Hemodynamic and Pulmonary Function During Cardiopulmonary Resuscitation in Pigs

Circulation ◽

10.1161/circ.116.suppl_16.ii_927-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Peter Paal ◽

Andreas Neurauter ◽

Michael Loedl ◽

Daniel Pehböck ◽

Holger Herff ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Pulmonary Function ◽

Partial Pressure ◽

Basic Life Support ◽

Life Support ◽

Coronary Perfusion Pressure ◽

Spontaneous Circulation ◽

Coronary Perfusion ◽

Arterial Partial Pressure ◽

Stomach Inflation

Background : Stomach inflation during cardiopulmonary resuscitation (CPR) is frequent. The purpose of this study was to evaluate effects of different levels of stomach inflation on hemodynamic and pulmonary function during CPR in a porcine model. Methods: After 4min of ventricular fibrillation, randomization to 0, 5, or 10L of stomach inflation was performed in 21 piglets. Basic life support CPR was then initiated for 3min, followed by a combination of epinephrine (45mcg/kg) and vasopressin (0.4U/kg) and defibrillation 2min later, and a post resuscitation phase of 30min. Kruskal-Wallis test was used for analysis; results are given as median (range). Results : During basic life support CPR, 0, 5, and 10L stomach inflation resulted in comparable coronary perfusion pressure between groups [10 (2–20), 8 (4–35), and 5 (0 –18) mmHg, respectively]. Increasing (0, 5, and 10L) stomach inflation resulted in significantly (P<.05) decreasing static pulmonary compliance [52 (38 –98), 19 (8 –32), and 12 (7–15) mL/cmH 2 O, respectively], and significantly increasing mean airway pressure during mechanical ventilation [14 (12–15), 26 (20 – 66), and 40 (13– 46) cmH 2 O]. Arterial partial pressure of oxygen was significantly higher with 0L when compared with 5 and 10L stomach inflation, but comparable between 5 and 10L stomach inflation [378 (88–440), 58 (47–113), and 54 (43–126) mmHg, respectively]. Similarly, arterial partial pressure of carbon dioxide was significantly lower with 0L when compared with 5 and 10L of stomach inflation [30 (24–36), 41(34 –51), and 56 (45– 68) mmHg, respectively]. Return of spontaneous circulation rates were comparable between groups [5/7 in 0L, 4/7 in 5L, and 3/7 in 10L stomach inflation]. Conclusion : In this CPR model, increasing levels of stomach inflation had adverse effects on pulmonary, but not on hemodynamic function.

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Abstract 132: Neurological Favorable Outcome Associated With Number of Prehospital Defibrillation Attempts in Out-of-Hospital Cardiac Arrest Without Return of Spontaneous Circulation on Scene

Circulation ◽

10.1161/circ.138.suppl_2.132 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Seulki Choi ◽

Tae Han Kim ◽

Ki Jeong Hong ◽

Sung Wook Song ◽

Joo Jeong ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Life Support ◽

Discharge Rate ◽

Spontaneous Circulation ◽

Successful Resuscitation ◽

Return Of Spontaneous Circulation ◽

Hospital Transport ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Background: The early and timely defibrillation in shockable rhythm of out-of-hospital cardiac arrest (OHCA) by prehospital EMS providers is crucial for successful resuscitation. In emergency medical service (EMS) system, where advanced cardiac life support could not be fully provided before hospital transport, optimal range of prehospital defibrillation attempts is debatable. We evaluated association between number of prehospital defibrillation attempts and survival outcomes in OHCA patients who were unresponsive to field resuscitation and defibrillations. Methods: This is a retrospective observational study using nationwide OHCA registry of Korea from 2013 to 2016. Adult EMS treated OHCA with presumed cardiac origin with shockable initial ECG rhythm were enrolled. Final analysis was performed in patients who did not achieve return of spontaneous circulation (ROSC) on scene before hospital transport. We categorized number of prehospital defibrillation attempt into 3 groups: ≤3 attempts, 4-5 attempts and ≥6 attempts. Primary outcome was favorable neurological outcome at hospital discharge. Multivariable logistic regression modeling was used to evaluate association between neurological outcome and defibrillation attempts. Result: Total 6,679 patients were enrolled for final analyzed. Among total ≤3 defibrillations were attempted in 5015 patients (75.1%), 1050 patients (15.7%) for 4-5 attempts, 614 patient. (9.2%) for ≥6 attempts. Although survival to discharge rate was highest in group with ≤3 defibrillation attempts (8.1% vs. 7.0% vs. 2.9%, p<0.01), survival rate with favorable neurological outcome was highest in group with 4-5 defibrillation attempts (3.0% vs. 4.5% vs. 2.1%, p=0.02). As 4-5 attempts group reference, adjusted odds ratio for favorable neurological outcome of ≤3 attempts was 0.66 (95% CI 0.46 - 0.94) and of ≥6 attempts was 0.47 (95% CI 0.25 - 0.89). Conclusion: For patients with shockable initial cardiac rhythm who were unresponsive to filed defibrillation and resuscitation, moderate amount of defibrillation attempt was associated with favorable neurological outcome compared to fewer defibrillation attempts and prolonged number of defibrillation attempts on scene.

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Abstract 358: Aortic Balloon Occlusion Augments the Efficacy of External Cardiopulmonary Resuscitation After Traumatic Cardiac Arrest in Swine

Circulation ◽

10.1161/circ.138.suppl_2.358 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Jiefeng Xu ◽

Peng Shen ◽

Senlin Xia ◽

Yuzhi Gao ◽

Shaoyun Liu ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Perfusion ◽

Coronary Perfusion Pressure ◽

Balloon Occlusion ◽

Control Group ◽

Swine Model ◽

Coronary Perfusion ◽

Traumatic Cardiac Arrest ◽

Aortic Balloon Occlusion

Introduction: Following hemorrhage-induced traumatic cardiac arrest (TCA), the effectiveness of standard cardiopulmonary resuscitation (CPR) would be weakened or lost due to an inadequate circulating volume. Previous investigations demonstrated that aortic balloon occlusion (ABO) could control the bleeding and increase proximal organ perfusion during severe traumatic hemorrhage. In this study, we investigated the effect of ABO on the efficacy of CPR in a swine model of TCA. Hypothesis: ABO initiated during CPR would increase cardiac and cerebral perfusion so as to improve the outcomes of resuscitation after TCA in swine. Methods: Twenty-seven male domestic swine weighing 33±4 kg were utilized. Forty percent of estimated blood volume was removed within 20 mins. The animals were then subjected to 5 mins of untreated ventricular fibrillation and 5 mins of CPR. Coincident with the start of CPR, the animals were randomized to receive ABO (n=15) or control (n=12). Meanwhile, normal saline was intravenously infused at a speed of 0.7 ml/kg/min in all animals. Results: During CPR, significantly greater coronary perfusion pressure, regional cerebral oxygen saturation and end-tidal CO 2 were observed in animals treated with ABO when compared with the control group (Table). Consequently, the rate of resuscitation success was significantly higher in the ABO group than in the control group (15/15 vs. 9/12, p = 0.040). Additionally, shorter duration of CPR (5.1±0.5 vs. 7.5±4.5 min, p = 0.054) and less number of shocks (1.1±0.3 vs. 2.0±1.8, p = 0.058) were required for establishing spontaneous circulation in the ABO group compared to the control group. Conclusion: The implementation of ABO during CPR significantly increased cardiac and cerebral perfusion and improved the outcomes of resuscitation in TCA following massive hemorrhage.

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Establishment of a swine model of traumatic cardiac arrest induced by haemorrhage and ventricular fibrillation

Journal of International Medical Research ◽

10.1177/0300060520931260 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052093126

Author(s):

Peng Shen ◽

Jie-Feng Xu ◽

Yu-Zhi Gao ◽

Sen-Lin Xia ◽

Shao-Yun Liu ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Sham Group ◽

Spontaneous Circulation ◽

Organ Injury ◽

Swine Model ◽

Successful Resuscitation ◽

Protein Levels ◽

Traumatic Cardiac Arrest ◽

Neurological Injuries

Objective To establish and evaluate a swine model of traumatic cardiac arrest (TCA) induced by haemorrhage and ventricular fibrillation. Methods Thirteen male pigs were divided into a sham group ( n = 5) and TCA group ( n = 8). Animals in the sham-operated group underwent intubation and monitoring but not haemorrhage and resuscitation, while animals in the TCA group underwent 40% blood volume haemorrhage over 20 min followed by 5 min of ventricular fibrillation and 5 min of cardiopulmonary resuscitation with fluid resuscitation. Results Restoration of spontaneous circulation was achieved in seven of eight animals in the TCA group. After resuscitation, the heart rate was significantly increased while the mean arterial pressure and ejection fraction were significantly decreased in the TCA group. The TCA group had significant cardiac and neurological injuries post-resuscitation and had higher serum creatinine and blood lactic acid levels and lower PaO2 than the sham group. Animals in the TCA group also exhibited significantly higher apoptotic indices and caspase-3 protein levels in the heart, brain and kidney than the sham group. Conclusion Animals in this swine model of TCA exhibited high rates of successful resuscitation, significant vital organ injury and prolonged survival. The model is suitable for use in further TCA research.

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