Risk Factor Analyses for the Return of Spontaneous Circulation in the Asphyxiation Cardiac Arrest Porcine Model

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.

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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 ◽

10.1161/circ.138.suppl_2.326 ◽

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.

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Loperamide Induced Recurrent Torsades de Pointes: A Case Report

Journal of Pharmacy Practice ◽

10.1177/08971900211004832 ◽

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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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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