scholarly journals Frontal EEG Changes with the Recovery of Carotid Blood Flow in a Cardiac Arrest Swine Model

Sensors ◽  
2020 ◽  
Vol 20 (11) ◽  
pp. 3052
Author(s):  
Heejin Kim ◽  
Ki Hong Kim ◽  
Ki Jeong Hong ◽  
Yunseo Ku ◽  
Sang Do Shin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Circulation ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Swine Model ◽  
Carotid Blood Flow ◽  
Non Invasive ◽  
Entropy Measures ◽  
Palpable Pulse ◽  
Eeg Changes

Monitoring cerebral circulation during cardiopulmonary resuscitation (CPR) is essential to improve patients’ prognosis and quality of life. We assessed the feasibility of non-invasive electroencephalography (EEG) parameters as predictive factors of cerebral resuscitation in a ventricular fibrillation (VF) swine model. After 1 min untreated VF, four cycles of basic life support were performed and the first defibrillation was administered. Sustained return of spontaneous circulation (ROSC) was confirmed if a palpable pulse persisted for 20 min. Otherwise, one cycle of advanced cardiovascular life support (ACLS) and defibrillation were administered immediately. Successfully defibrillated animals were continuously monitored. If sustained ROSC was not achieved, another cycle of ACLS was administered. Non-ROSC was confirmed when sustained ROSC did not occur after 10 ACLS cycles. EEG and hemodynamic parameters were measured during experiments. Data measured for approximately 3 s right before the defibrillation attempts were analyzed to investigate the relationship between the recovery of carotid blood flow (CBF) and non-invasive EEG parameters, including time- and frequency-domain parameters and entropy indices. We found that time-domain magnitude and entropy measures of EEG correlated with the change of CBF. Further studies are warranted to evaluate these EEG parameters as potential markers of cerebral circulation during CPR.

scholarly journals Resuscitative endovascular balloon occlusion of the aorta vs epinephrine in the treatment of non-traumatic cardiac arrest in swine

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alice Hutin ◽  
Yaël Levy ◽  
Fanny Lidouren ◽  
Matthias Kohlhauer ◽  
Pierre Carli ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Life Support ◽  
Statistical Significance ◽  
Spontaneous Circulation ◽  
Balloon Occlusion ◽  
Swine Model ◽  
Epinephrine Administration ◽  
Traumatic Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Abstract Background The administration of epinephrine in the management of non-traumatic cardiac arrest remains recommended despite controversial effects on neurologic outcome. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) could be an interesting alternative. The aim of this study was to compare the effects of these 2 strategies on return of spontaneous circulation (ROSC) and cerebral hemodynamics during cardiopulmonary resuscitation (CPR) in a swine model of non-traumatic cardiac arrest. Results Anesthetized pigs were instrumented and submitted to ventricular fibrillation. After 4 min of no-flow and 18 min of basic life support (BLS) using a mechanical CPR device, animals were randomly submitted to either REBOA or epinephrine administration before defibrillation attempts. Six animals were included in each experimental group (Epinephrine or REBOA). Hemodynamic parameters were similar in both groups during BLS, i.e., before randomization. After epinephrine administration or REBOA, mean arterial pressure, coronary and cerebral perfusion pressures similarly increased in both groups. However, carotid blood flow (CBF) and cerebral regional oxygenation saturation were significantly higher with REBOA as compared to epinephrine administration (+ 125% and + 40%, respectively). ROSC was obtained in 5 animals in both groups. After resuscitation, CBF remained lower in the epinephrine group as compared to REBOA, but it did not achieve statistical significance. Conclusions During CPR, REBOA is as efficient as epinephrine to facilitate ROSC. Unlike epinephrine, REBOA transitorily increases cerebral blood flow and could avoid its cerebral detrimental effects during CPR. These experimental findings suggest that the use of REBOA could be beneficial in the treatment of non-traumatic cardiac arrest.

Limitations of Abdominal Binding during CPR

1985 ◽  
Vol 1 (S1) ◽  
pp. 227-229
Author(s):  
James K. Alifimoff ◽  
Peter Safar ◽  
Nicholas Bircher
Keyword(s):  
Blood Flow ◽  
Rural Areas ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Western World ◽  
Carotid Blood Flow ◽  
Fluid Load ◽  
The Usa

Sudden cardiac death is the number one killer in the western world. In the USA alone, CPR attempts are justified in 200,000 cases per year. Recovery of brain function requires immediate initiation and uninterrupted maintenance of artificial ventilation and circulation by basic life support (BLS) until restoration of spontaneous circulation (ROSC) is possible with advanced life support (ALS). Presently recommended standard CPR (SCPR) produces only 6–30% of normal common carotid blood flow. For this reason, a more effective method of prolonged CPR-BLS is necessary in the absence of ALS ambulance services, which is common in rural areas.Augmentation of blood flow during CPR can be accomplished by intravenous fluid load and epinephrine, which are unavailable to BLS personnel. Sustained abdominal compression in dogs during CPR increases blood flow but produces a high incidence of hepatic trauma. The use of military anti-shock trousers (MAST) during short-term SCPR has been shown to increase common carotid blood flow (CCABF); this, however, has not been evaluated with a long-term model.

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

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.

scholarly journals Effects of Erythropoietin Administration on Adrenal Glands of Landrace/Large White Pigs after Ventricular Fibrillation

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Armando Faa ◽  
Gavino Faa ◽  
Apostolos Papalois ◽  
Eleonora Obinu ◽  
Giorgia Locci ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Adrenal Glands ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Control Group ◽  
Swine Model ◽  
Protective Effects ◽  
Large White ◽  
Significant Difference

Aim.To evaluate the effects of erythropoietin administration on the adrenal glands in a swine model of ventricular fibrillation and resuscitation.Methods. Ventricular fibrillation was inducedviapacing wire forwarded into the right ventricle in 20 female Landrace/Large White pigs, allocated into 2 groups: experimental group treated with bolus dose of erythropoietin (EPO) and control group which received normal saline. Cardiopulmonary resuscitation (CPR) was performed immediately after drug administrationas perthe 2010 European Resuscitation Council (ERC) guidelines for Advanced Life Support (ALS) until return of spontaneous circulation (ROSC) or death. Animals who achieved ROSC were monitored, mechanically ventilated, extubated, observed, and euthanized. At necroscopy, adrenal glands samples were formalin-fixed, paraffin-embedded, and routinely processed. Sections were stained with hematoxylin-eosin.Results.Oedema and apoptosis were the most frequent histological changes and were detected in all animals in the adrenal cortex and in the medulla. Mild and focal endothelial lesions were also detected. A marked interindividual variability in the degree of the intensity of apoptosis and oedema at cortical and medullary level was observed within groups. Comparing the two groups, higher levels of pathological changes were detected in the control group. No significant difference between the two groups was observed regarding the endothelial changes.Conclusions. In animals exposed to ventricular fibrillation, EPO treatment has protective effects on the adrenal gland.

Abstract 139: Impedance Threshold Device and Active Decompression Improve Hemodynamics in a Swine Model of Prolonged CPR

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Joshua W Lampe ◽  
Yin Tai ◽  
Anja K Metzger ◽  
Christopher L Kaufman ◽  
Lance B Becker
Keyword(s):  
Blood Flow ◽  
Chest Compression ◽  
Zero Point ◽  
Swine Model ◽  
Carotid Blood Flow ◽  
Blood Flows ◽  
Lift Height ◽  
Threshold Device ◽  
Acd Cpr ◽  
Impedance Threshold Device

Introduction: Cardiopulmonary resuscitation with the impedance threshold device and active decompression (ITD-ACD CPR) has been shown to improve chest compression generated blood flow relative to standard chest compression. Using our high-fidelity swine model of cardiac arrest treated with prolonged mechanical chest compression (MCC) we studied the effect of different lift heights (amount of lift above the natural zero point of the sternum) during active decompression. Methods: CPR was performed on six domestic swine (~30 kg) using standard physiological monitoring. Flow was measured in the abdominal aorta, inferior vena cava (IVC), right common carotid and external jugular, and left femoral artery. Ventricular fibrillation (VF) was electrically induced. MCC were started after ten minutes of VF. Four MCC waveforms were used: Standard CPR (2”, 100 CPM), and ITD-ACD CPR (2”, 80 CPM) with 0.5”, 1.0”, and 1.5” lift past the zero point. MCC waveforms were changed every 2 min in a crossover design and delivered for 56 minutes. Data were analyzed in CPR cycles which included four epochs of CPR, one of each waveform, constituting 8 minutes of compressions. Results: Lift height had a significant (p<0.05) effect on carotid and jugular blood flow. Lift heights of 1.0 and 1.5” generated significantly more carotid blood flow in all 7 CPR cycles. A lift height of 1.5” generated significantly more jugular blood flow over all 7 CPR cycles. The interaction between duration of CPR and Jugular blood flow previously observed using this animal model was not observed. Carotid and jugular blood flow as a function of waveform and CPR cycle are shown in the figure. Conclusions: ITD-ACD CPR improved carotid and jugular blood flows, suggestive of improved cerebral perfusion. A lift height of 1.5” was required for significant improvement of jugular blood flows, while ITD-ACD CPR provided significantly better carotid blood flow than standard CPR at all lift heights.

scholarly journals EEG-Based Prediction of the Recovery of Carotid Blood Flow during Cardiopulmonary Resuscitation in a Swine Model

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3650
Author(s):  
Heejin Kim ◽  
Ki Hong Kim ◽  
Ki Jeong Hong ◽  
Yunseo Ku ◽  
Sang Do Shin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Resuscitation ◽  
Nearest Neighbor ◽  
Polynomial Kernel ◽  
Support Vector ◽  
Swine Model ◽  
K Nearest Neighbor ◽  
Carotid Blood Flow ◽  
Time Frequency ◽  
Svm Model

The recovery of cerebral circulation during cardiopulmonary resuscitation (CPR) is important to improve the neurologic outcomes of cardiac arrest patients. To evaluate the feasibility of an electroencephalogram (EEG)-based prediction model as a CPR feedback indicator of high- or low-CBF carotid blood flow (CBF), the frontal EEG and hemodynamic data including CBF were measured during animal experiments with a ventricular fibrillation (VF) swine model. The most significant 10 EEG parameters in the time, frequency and entropy domains were determined by neighborhood component analysis and Student’s t-test for discriminating high- or low-CBF recovery with a division criterion of 30%. As a binary CBF classifier, the performances of logistic regression, support vector machine (SVM), k-nearest neighbor, random forest and multilayer perceptron algorithms were compared with eight-fold cross-validation. The three-order polynomial kernel-based SVM model showed the best accuracy of 0.853. The sensitivity, specificity, F1 score and area under the curve of the SVM model were 0.807, 0.906, 0.853 and 0.909, respectively. An automated CBF classifier derived from non-invasive EEG is feasible as a potential indicator of the CBF recovery during CPR in a VF swine model.

Impact of Different Perfusion Modalities on Coronary and Carotid Blood Flow Velocities in an Adult ECLS Swine Model

2018 ◽  
Vol 42 (9) ◽  
pp. 918-921 ◽  
Author(s):  
Shigang Wang ◽  
Sunil Patel ◽  
Jenelle M. Izer ◽  
Joseph B. Clark ◽  
Allen R. Kunselman ◽  
...  
Keyword(s):  
Blood Flow ◽  
Swine Model ◽  
Carotid Blood Flow ◽  
Blood Flow Velocities ◽  
Flow Velocities

scholarly journals O10 Myocardial tolerance to exsanguination and retrieval using whole blood-selective aortic arch perfusion

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
M J Madurska ◽  
N N Elansary ◽  
N Pate ◽  
J Edwards ◽  
M J Richmond ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Aortic Arch ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Spontaneous Circulation ◽  
Treatment Modalities ◽  
Swine Model ◽  
Male Adult ◽  
Resuscitation Fluid ◽  
Baseline Characteristics

Abstract Introduction Exsanguination cardiac arrest is the leading preventable cause of death in trauma. Treatment modalities are limited, and prognosis remains dismal. Selective aortic arch perfusion (SAAP) is an emerging endovascular resuscitation technique consisting of aortic occlusion and perfusion of coronary and cerebral circulation with oxygenated resuscitation fluid. Translational research has demonstrated promising outcomes; however, little is known about the duration of cardiac arrest beyond which the myocardium cannot be resuscitated. The aims of this study are to assess the myocardial tolerance to exsanguination cardiac arrest before successful return of spontaneous circulation (ROSC) following resuscitation with SAAP, and 1-hour survival. Method 23 male adult swine were anaesthetised and instrumented. Controlled hemorrhage was performed until cardiac arrest defined by MAP &lt;20 mmHg. Animals were randomized into 3 groups: 5, 10 and 15 minutes of cardiac arrest before resuscitation with SAAP. Following ROSC animals were observed for 60 minutes. Result Baseline characteristics were similar between groups (P &gt; 0.05). ROSC was 100% (8/8) in the 5 min group, 75% (6/8) and 43% (3/7) in 10- and 15-min groups respectively (P = 0.042). 60 min survival was 75%, 50% and 14% in 5-, 10- and 15-min groups respectively (P = 0.015). 1-hour survivors in the 5 min group required less noradrenaline 23.6 (±7.4) compared to other animals 40.9 (±25.8), (P = 0.008). Conclusion Selective aortic arch perfusion is an effective resuscitative tool in eliciting ROSC in a swine model of exsanguination cardiac arrest lasting &gt;5 min. Sustainable resuscitability using SAAP declines after 10 min of exsanguination cardiac arrest. Take-home Message SAAP is an emerging resuscitation technique with promising outcomes in exsanguination cardiac arrest and may be a segway to Extracorporeal life support. The time limit for resuscitability of the myocardium lies somewhere between 10 and 15 min after the start of exsanguination cardiac arrest.

scholarly journals Rewarming With Closed Thoracic Lavage Following 3-h CPR at 27°C Failed to Reestablish a Perfusing Rhythm

2021 ◽  
Vol 12 ◽  
Author(s):  
Joar O. Nivfors ◽  
Rizwan Mohyuddin ◽  
Torstein Schanche ◽  
Jan Harald Nilsen ◽  
Sergei Valkov ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Cardiac Output ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Aerobic Metabolism ◽  
Organ Blood Flow ◽  
Circulatory Collapse ◽  
Low Levels ◽  
Modest Reduction

Introduction: Previously, we showed that the cardiopulmonary resuscitation (CPR) for hypothermic cardiac arrest (HCA) maintained cardiac output (CO) and mean arterial pressure (MAP) to the same reduced level during normothermia (38°C) vs. hypothermia (27°C). In addition, at 27°C, the CPR for 3-h provided global O2 delivery (DO2) to support aerobic metabolism. The present study investigated if rewarming with closed thoracic lavage induces a perfusing rhythm after 3-h continuous CPR at 27°C.Materials and Methods: Eight male pigs were anesthetized, and immersion-cooled. At 27°C, HCA was electrically induced, CPR was started and continued for a 3-h period. Thereafter, the animals were rewarmed by combining closed thoracic lavage and continued CPR. Organ blood flow was measured using microspheres.Results: After cooling with spontaneous circulation to 27°C, MAP and CO were initially reduced by 37 and 58% from baseline, respectively. By 15 min after the onset of CPR, MAP, and CO were further reduced by 58 and 77% from baseline, respectively, which remained unchanged throughout the rest of the 3-h period of CPR. During CPR at 27°C, DO2 and O2 extraction rate (VO2) fell to critically low levels, but the simultaneous small increase in lactate and a modest reduction in pH, indicated the presence of maintained aerobic metabolism. During rewarming with closed thoracic lavage, all animals displayed ventricular fibrillation, but only one animal could be electro-converted to restore a short-lived perfusing rhythm. Rewarming ended in circulatory collapse in all the animals at 38°C.Conclusion: The CPR for 3-h at 27°C managed to sustain lower levels of CO and MAP sufficient to support global DO2. Rewarming accidental hypothermia patients following prolonged CPR for HCA with closed thoracic lavage is not an alternative to rewarming by extra-corporeal life support as these patients are often in need of massive cardio-pulmonary support during as well as after rewarming.

The comparison of humeral intraosseous and intravenous administration of vasopressin on return of spontaneous circulation and pharmacokinetics in a hypovolemic cardiac arrest swine model

2016 ◽  
Vol 11 (4) ◽  
pp. 237-242 ◽  
Author(s):  
Mark H. Wimmer, BSN ◽  
Kenneth Heffner, BSN ◽  
Michael Smithers, BSN ◽  
Richard Culley, BSN ◽  
Jennifer Coyner, PhD, CRNA ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Analysis Of Variance ◽  
Repeated Measures ◽  
Maximum Concentration ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Control Group ◽  
Swine Model ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference

Introduction: The American Heart Association (AHA) recommends intravenous (IV) or intraosseous (IO) vasopressin in Advanced Cardiac Life Support (ACLS). Obtaining IV access in hypovolemic cardiac arrest patients can be difficult, and IO access is often obtained in these life threatening situations. No studies have been conducted to determine the effects of humeral IO (HIO) access with vasopressin in the return of spontaneous circulation (ROSC). Our study compared the kinetics of vasopressin and ROSC with HIO with IV access in the hypovolemic swine model.Methods: Twenty-two Yorkshire swine were divided into three groups: HIO (n = 7), IV (n = 8), and a control group (n = 7). The IV and HIO group received vasopressin and cardiopulmonary resuscitation (CPR), while the control group received only CPR. All subjects were exsanguinated 31 percent of their blood volume, placed in cardiac arrest, and resuscitated per ACLS. Subjects that achieved ROSC were then monitored for 20 minutes. Blood samples (10 mL) collected at 0.5, 1, 1.5, 2, 2.5, 3, and 4 minutes after vasopressin injection and analyzed for maximum concentration (Cmax) and time to maximum concentration (Tmax). Data were analyzed using a multivariate analysis of variance (MANOVA) and a Fisher's Exact Test.Results: ROSC was achieved in every subject that received vasopressin via the HIO route. Data analysis using a MANOVA pairwise comparison revealed no difference between mean Cmax (p = 0.601) and Tmax (p = 0.771) of vasopressin administered IV versus HIO routes. Analysis of the mean serum concentrations at time intervals using a repeated measures analysis of variance found no difference (p 0.05). A Fisher's Exact Test revealed no difference in rate of ROSC between HIO and IV groups (p 0.05). Odds ratio determined that there was a 33 times higher chance of survival among HIO subjects versus control (CPR and Defibrillation; p = 0.03) and no difference in the survivability of the HIO or IV groups (p = 0.52). Conclusion: The data from this study strongly suggest that there is no significant difference in ROSC, time to ROSC, hemodynamics, or pharmacokinetics between HIO vasopressin and IV vasopressin. This research reinforces current AHA guidelines recommending the use of HIO route early over delaying care awaiting IV access.

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