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.

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.

scholarly journals The Physiologic Response to Rescue Therapy with Vasopressin versus Epinephrine during Experimental Pediatric Cardiac Arrest

2020 ◽  
Author(s):  
Julia Slovis ◽  
Ryan Morgan ◽  
William Landis ◽  
Anna L Roberts ◽  
Constantine Mavroudis ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Perfusion Pressure ◽  
Rescue Therapy ◽  
Coronary Perfusion Pressure ◽  
Coronary Perfusion ◽  
Cerebral Vasculature ◽  
Chest Compressions ◽  
Rescue Dose ◽  
Physiologic Response ◽  
Hospital Cardiac Arrest

Abstract Background: While epinephrine is the mainstay of therapy during cardiopulmonary resuscitation, it is potentially detrimental to the cerebral vasculature and ineffective in certain populations. This study compares a rescue dose of vasopressin to a rescue dose of epinephrine after ineffective initial doses of epinephrine in diverse models of pediatric in-hospital cardiac arrest. 67 one- to three-month old female swine (10-30kg) in six experimental cohorts from one laboratory received hemodynamic-directed CPR, a resuscitation method where high quality chest compressions are provided and vasopressor administration is titrated to coronary perfusion pressure (CoPP) ³20 mmHg. Vasopressors are given when CoPP is <20 mmHg, in sequences of two doses of 0.02 mg/kg epinephrine separated by minimum one-minute, then a rescue dose of 0.4 U/kg vasopressin followed by minimum two-minutes. Invasive measurements were used to evaluate and compare the hemodynamic and neurologic effects of each vasopressor dose. Results: Increases in CoPP and cerebral blood flow (CBF) were greater with vasopressin rescue than epinephrine rescue (CoPP: +8.16 [4.35, 12.06] mmHg vs. +5.43 [1.56, 9.82] mmHg, p=0.022; CBF: +14.58 [-0.05, 38.12] vs. +0.00 [-0.77, 18.24] perfusion units (PFU), p=0.005). Twenty animals (30%) failed to achieve CoPP ³20 mmHg after two doses of epinephrine; 9/20 (45%) non-responders achieved CoPP ³20 mmHg after vasopressin. Among all animals, the increase in CBF was greater with vasopressin (+14.58 [-0.58, 38.12] vs. 0.00 [-0.77, 18.24] PFU, p=0.005).Conclusions: CoPP and CBF rose significantly more after rescue vasopressin than after rescue epinephrine. Importantly, CBF increased after vasopressin rescue, but not after epinephrine rescue. In the 30% that failed to meet CoPP of 20mmHg after two doses of epinephrine, 45% achieved target CoPP with a single rescue vasopressin dose.

Abstract P115: Higher Threshold and Dose of Coronary Perfusion Pressure are Associated with ROSC in Prolonged Swine Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Joshua C Reynolds ◽  
David D Salcido ◽  
James J Menegazzi
Keyword(s):  
Cardiac Arrest ◽  
Myocardial Perfusion ◽  
Regression Models ◽  
Perfusion Pressure ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Coronary Perfusion ◽  
Experimental Protocol ◽  
Total Flow ◽  
Mechanical Cpr

Introduction: The amount of myocardial perfusion required for successful defibrillation after prolonged cardiac arrest is not known. Coronary perfusion pressure (CPP) is a surrogate for myocardial perfusion. One limited clinical study reported that a threshold of 15mmHg was necessary for return of spontaneous circulation (ROSC), and that CPP was predictive of ROSC. A distinction between threshold and dose of CPP has not been reported. Hypothesis: Animals that achieve ROSC will have higher mean CPP and higher area under the CPP curve (AUC) than no-ROSC swine. Methods: Data from 4 similar swine cardiac arrest studies were retrospectively pooled. Animals had undergone 8 –11 minutes of untreated ventricular fibrillation, 2 minutes of mechanical CPR, administration of drugs, and 3 more minutes of CPR prior to the first shock. Mean CPP ± standard error was derived from the last 20 compressions of each 30 second epoch of CPR and compared between ROSC/no-ROSC groups by RM-ANOVA. AUC for all compressions delivered over the 5 minutes was calculated by direct summation and compared by Kruskal-Wallis test. Prediction of ROSC was assessed by logistic regression. Results : During 5 minutes of CPR (n=80), mean CPP ± SEM was higher in animals with ROSC (n=63) (p < 0.001). Animals with ROSC received more total flow than animals without ROSC (p < 0.001). Two regression models identified CPP (OR 1.11; 95% CI 1.05, 1.18) and AUC (OR 1.10; 95% CI 1.05, 1.16) as predictors of ROSC. Experimental protocol also predicted ROSC in each model (OR 1.70; 95% CI 1.15, 2.50) and (OR 1.59; 95% CI 1.12, 2.25), respectively. Conclusion : Higher CPP threshold and dose are associated with and predictive of ROSC.

Cardiac Resuscitation

2012 ◽  
Author(s):  
Charles N. Pozner ◽  
Jennifer L Martindale ◽  
Brian C. Geyer
Keyword(s):  
Cardiac Arrest ◽  
Heart Association ◽  
The United States ◽  
Coronary Perfusion Pressure ◽  
Coronary Perfusion ◽  
Chest Compressions ◽  
Neurologic Recovery ◽  
Cardiac Resuscitation ◽  
Postresuscitation Care ◽  
Large Pericardial Effusion

Over 1,000 people suffer sudden cardiac death every day in the United States. About half occur in the hospital, the remainder occurring in the home, outpatient medical environments, or public spaces. The ultimate goal of cardiac resuscitation is survival with full neurologic recovery. Interventions that have the greatest potential to provide this outcome are often those interventions that can be performed by trained laypersons. Delay in the initiation of compressions in a cardiac arrest is one of the leading predictors of mortality. This chapter deliberately opens with a discussion of one of the most vital, yet relatively under-appreciated aspects of cardiac resuscitation—teamwork. Following an overview of cardiac arrest, the chapter covers epidemiology and recognition of cardiac arrest, then activation of the emergency response system. Chest compressions, defibrillation and airway management are discussed, then end-tidal CO2, vascular access, rhythm analysis during cardiac arrest, and drugs used during cardiac resuscitation. The chapter concludes with a look at postresuscitation care, special considerations in cardiac arrest, and future directions. Figures include the foundations of cardiac resuscitation, a management algorithm for the initial treatment of cardiac arrest, coronary perfusion pressure as a function of time, an impedance threshold device incorporated into a bag-valve mask, a colorimetric CO2 detector, four basic phases of a capnogram, sample capnographs, a battery-powered intraosseous drill, electrocardiogram readouts of ventricular arrhythmias, a sonogram of large pericardial effusion, and electrocardiographic appearance of varying degrees of hyperkalemia. Tables summarize recommendations from the American Heart Association, the components of optimal and suboptimal chest compressions, and underlying causes of nonshockable rhythms and their management. This chapter contains 11 highly rendered figures, 3 tables, 138 references, 5 MCQs.

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 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.

scholarly journals Swine model in cardiopulmonary resuscitation research

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.

scholarly journals Cardiac arrest complicating cardiogenic shock: from pathophysiological insights to Impella-assisted cardiopulmonary resuscitation in a pheochromocytoma-induced Takotsubo cardiomyopathy—a case report

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Filippo Zilio ◽  
Simone Muraglia ◽  
Roberto Bonmassari
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Left Ventricle ◽  
Cardiogenic Shock ◽  
Takotsubo Cardiomyopathy ◽  
Perfusion Pressure ◽  
Coronary Perfusion Pressure ◽  
Left Ventricular ◽  
Coronary Perfusion ◽  
Refractory Cardiac Arrest

Abstract Background A ‘catecholamine storm’ in a case of pheochromocytoma can lead to a transient left ventricular dysfunction similar to Takotsubo cardiomyopathy. A cardiogenic shock can thus develop, with high left ventricular end-diastolic pressure and a reduction in coronary perfusion pressure. This scenario can ultimately lead to a cardiac arrest, in which unloading the left ventricle with a peripheral left ventricular assist device (Impella®) could help in achieving the return of spontaneous circulation (ROSC). Case summary A patient affected by Takotsubo cardiomyopathy caused by a pheochromocytoma presented with cardiogenic shock that finally evolved into refractory cardiac arrest. Cardiopulmonary resuscitation was performed but ROSC was achieved only after Impella® placement. Discussion In the clinical scenario of Takotsubo cardiomyopathy due to pheochromocytoma, when cardiogenic shock develops treatment is difficult because exogenous catecholamines, required to maintain organ perfusion, could exacerbate hypertension and deteriorate the cardiomyopathy. Moreover, as the coronary perfusion pressure is critically reduced, refractory cardiac arrest could develop. Although veno-arterial extra-corporeal membrane oxygenation (va-ECMO) has been advocated as the treatment of choice for in-hospital refractory cardiac arrest, in the presence of left ventricular overload a device like Impella®, which carries fewer complications as compared to ECMO, could be effective in obtaining the ROSC by unloading the left ventricle.

Sign in / Sign up

Export Citation Format

Share Document