Journal Article

Outcomes from low versus high-flow cardiopulmonary resuscitation in a swine model of cardiac arrest

Paradis, Norman A., Zviman, Menekhem, Kolandaivelu, Aravindan, Lardo, Albert, Halperin, Henry R., Lee, Kichang, Illindala, Uday

2010

Overview

Return of spontaneous circulation (ROSC) is improved by greater vital organ blood flow during cardiopulmonary resuscitation (CPR). We tested the hypothesis that myocardial flow above the threshold needed for ROSC may be associated with greater vital organ injury and worse outcome. Aortic and right atrial pressures were measured with micromanometers in 27 swine. After 10 minutes of untreated ventricular fibrillation, chest compression was performed with an automatic, load-distributing band. Animals were randomly assigned to receive flows just sufficient for ROSC (low flow: target coronary perfusion pressure = 12 mm Hg) or well above the minimally effective level (high flow: coronary perfusion pressure = 30 mm Hg). Myocardial flow was measured with microspheres, defibrillation was performed after 3.5 minutes of CPR, and ejection fraction was measured with echocardiography. Return of spontaneous circulation was achieved by 9 of 9 animals in the high-flow group and 15 of 18 in the low-flow group. All animals in the high-flow group defibrillated initially into a perfusing rhythm, whereas 12 of 15 animals achieving ROSC in the low-flow group defibrillated initially into pulseless electrical activity ( P < .05, Fisher exact test). Compared with animals in the low-flow group, animals in the high-flow group had shorter resuscitation times, higher mean aortic pressures at ROSC, and higher ejection fractions at 2 hours post-ROSC (all P < .05). High-flow CPR significantly improved arrest hemodynamics, rates of ROSC, and post-ROSC indicators of myocardial status, all indicating less injury with higher flows. No evidence of organ injury from vital organ blood flow substantially above the threshold for ROSC was found.

• Publisher: Elsevier Inc,Elsevier,Elsevier Limited
• Subject: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Animals / Biological and medical sciences / Cardiac arrest / Cardiopulmonary resuscitation / Cardiopulmonary Resuscitation - instrumentation / Cardiopulmonary Resuscitation - methods / Catheters / Confidence intervals / Coronary Circulation / Coronary vessels / CPR / Emergency / Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care / Emergency medical care / Heart Arrest - therapy / Heart attacks / Hemodynamics / Intensive care medicine / Ischemia / Laboratory animals / Medical sciences / Pressure / Random Allocation / Rates of return / Reperfusion - methods / Stroke Volume / Studies / Swine / Veins & arteries / Ventilation