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Reperfusion injury protection during Basic Life Support improves circulation and survival outcomes in a porcine model of prolonged cardiac arrest
- Source :
- Resuscitation, Resuscitation, Elsevier, 2016, 105, pp.29-35. ⟨10.1016/j.resuscitation.2016.05.008⟩
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Objective Ischemic postconditioning (PC) using three intentional pauses at the start of cardiopulmonary resuscitation (CPR) improves outcomes after cardiac arrest in pigs when epinephrine (epi) is used before defibrillation. We hypothesized PC, performed during basic life support (BLS) in the absence of epinephrine, would reduce reperfusion injury and enhance 24h functional recovery. Design Prospective animal investigation. Setting Animal laboratory Subjects Female farm pigs ( n =46, 39±1kg). Interventions Protocol A: After 12min of ventricular fibrillation (VF), 28 pigs were randomized to four groups: (A) Standard CPR (SCPR), (B) active compression-decompression CPR with an impedance threshold device (ACD-ITD), (C) SCPR+PC (SCPR+PC) and (D) ACD-ITD CPR+PC. Protocol B: After 15min of VF, 18 pigs were randomized to ACD-ITD CPR or ACD-ITD+PC. The BLS duration was 2.75min in Protocol A and 5min in Protocol B. Following BLS, up to three shocks were delivered. Without return of spontaneous circulation (ROSC), CPR was resumed and epi (0.5mg) and defibrillation delivered. The primary end point was survival without major adverse events. Hemodynamic parameters and left ventricular ejection fraction (LVEF) were also measured. Data are presented as mean±SEM. Measurements and Main Results Protocol A: ACD-ITD+PC (group D) improved coronary perfusion pressure after 3min of BLS versus the three other groups (28±6, 35±7, 23±5 and 47±7 for groups A, B, C, D respectively, p =0.05). There were no significant differences in 24h survival between groups. Protocol B LVEF 4h post ROSC was significantly higher with ACD-ITD+PC vs ACD-ITD alone (52.5±3% vs. 37.5±6.6%, p =0.045). Survival rates were significantly higher with ACD-ITD+PC vs. ACD-ITD alone ( p =0.027). Conclusions BLS using ACD-ITD+PC reduced post resuscitation cardiac dysfunction and improved functional recovery after prolonged untreated VF in pigs. Protocol number 12-11.
- Subjects :
- medicine.medical_specialty
Time Factors
Epinephrine
Swine
Defibrillation
medicine.medical_treatment
Electric Countershock
030204 cardiovascular system & hematology
Emergency Nursing
Return of spontaneous circulation
Random Allocation
03 medical and health sciences
0302 clinical medicine
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Internal medicine
Animals
Medicine
Prospective Studies
Cardiopulmonary resuscitation
Sympathomimetics
Ischemic Postconditioning
ComputingMilieux_MISCELLANEOUS
Ejection fraction
business.industry
Basic life support
030208 emergency & critical care medicine
Impedance threshold device
medicine.disease
Cardiopulmonary Resuscitation
Heart Arrest
Surgery
Disease Models, Animal
Reperfusion Injury
Blood Circulation
Ventricular fibrillation
Emergency Medicine
Coronary perfusion pressure
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 03009572
- Volume :
- 105
- Database :
- OpenAIRE
- Journal :
- Resuscitation
- Accession number :
- edsair.doi.dedup.....31adcfff34067b7b2d80c1e2a553a84e
- Full Text :
- https://doi.org/10.1016/j.resuscitation.2016.05.008