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Hopper K, Epstein SE, Burkitt-Creedon JM, Fletcher DJ, Boller M, Fausak ED, Mears K, Crews M. 2024 RECOVER Guidelines: Basic Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR. J Vet Emerg Crit Care (San Antonio) 2024; 34 Suppl 1:16-43. [PMID: 38924625 DOI: 10.1111/vec.13387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps. DESIGN Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation. CONCLUSIONS These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.
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Affiliation(s)
- Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Jamie M Burkitt-Creedon
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Daniel J Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Manuel Boller
- VCA Canada Central Victoria Veterinary Hospital, Victoria, British Columbia, Canada
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erik D Fausak
- University Library, University of California, Davis, Davis, California, USA
| | - Kim Mears
- Robertson Library, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Molly Crews
- Department of Small animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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Sun M, Li K, Xu F, Jiang L, Wang J, Xu F, Chen Y. High-Quality Chest Compression for Cardiopulmonary Resuscitation Using Newly-Designed Automatic Device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082569 DOI: 10.1109/embc40787.2023.10340167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
High-quality chest compression during cardiopulmonary resuscitation (CPR) can remarkably improve survival rate and reduce the risk of secondary injury. In this study, a newly-designed automatic chest compression device was applied on an animal model and the effects of chest compression were examined in comparison of manual compression and machine compression by a commercialized device. Three pigs (weight:30±2 kg) were used for the experiment. A LUCAS2 CPR machine and the newly-designed CPR device were used for automatic compression treatment. Compression pressure and chest displacement were collected in the process of CPR. Regarding the statistical distribution of compression depths, the new CPR device showed a mean of the depths at 1.64 inches, which was greater than that of manual (mean = 1.21 inches) and of LUCAS2 (mean = 1.18 inches). In addition, the new CPR device showed a standard deviation (SD) of compression depths at 0.07 inches, which was lower than that of manual (SD = 0.15 inches) and of LUCAS2 (SD = 0.25 inches). These results suggested that the new CPR device performed higher compression depths with lower compression variability, indicating enforced compression and better stability. This study provided a preliminarily outcomes validating the new CPR device, which may play a role in high-quality chest compression for the first aid in emergency.Clinical Relevance- This study established an animal model to validate a newly-designed automatic device for CPR. Comparing with manual chest compression and automatic compression using LUCAS2, the new device showed greater compression depths and better stability, which may provide more effective CPR treatment for clinical usage.
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Nichol G, Daya MR, Morrison LJ, Aufderheide TP, Vaillancourt C, Vilke GM, Idris A, Brown S. Compression depth measured by accelerometer vs. outcome in patients with out-of-hospital cardiac arrest. Resuscitation 2021; 167:95-104. [PMID: 34331984 DOI: 10.1016/j.resuscitation.2021.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Analyses of data recorded by monitor-defibrillators that measure CPR depth with different methods show significant relationships between the process and outcome of CPR. Our objective was to evaluate whether chest compression depth was significantly associated with outcome based on accelerometer-recordings obtained with monitor-defibrillators from a single manufacturer, and to assess whether an accelerometer-based analysis corroborated evidence-based practice guidelines on performance of CPR. METHODS AND RESULTS We included 5434 adult patients treated from seven US and Canadian cities between January 2007 and May 2015. These had mean (SD) age of 64.2 (17.2) years, mean compression depth of 45.9 (12.7) mm, ROSC sustained to ED arrival of 26%, and survival to hospital discharge of 8%. For survival to discharge, the adjusted odds ratios were 1.15 (95% CI, 0.86, 1.55) for cases within 2005 depth range (38-51 mm), and 1.17 (95% CI, 0.91, 1.50) for cases within 2010 depth range (>50 mm) compared to those with an average depth of <38 mm. The adjusted odds ratio of survival was 1.33 (95% CI, 1.01, 1.75) for cases within 2015 depth range (50 to 60 mm) for at least 60% of minutes. CONCLUSIONS This analysis of patients with OHCA demonstrated that increased chest compression depth measured by accelerometer is associated with better survival. It confirms that current evidence-based recommendations to compress within 50-60 mm are likely associated with greater survival than compressing to another depth.
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Affiliation(s)
- Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, Departments of Medicine and Emergency Medicine, University of Washington, Seattle, WA, United States.
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Laurie J Morrison
- Department of Emergency Medicine, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Christian Vaillancourt
- Ottawa Hospital Research Institute and Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gary M Vilke
- Department of Emergency Medicine, University of California, San Diego, CA, United States
| | - Ahamed Idris
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX, United States
| | - Siobhan Brown
- Department of Biostatistics, University of Washington, Seattle, WA, United States
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Effect of Shenfu Injection on Porcine Renal Function after Cardiopulmonary Resuscitation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:3789268. [PMID: 32382285 PMCID: PMC7193270 DOI: 10.1155/2020/3789268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022]
Abstract
Objective To comprehensively evaluate the protective effect of Shenfu injection (SFI) on renal ischaemia/reperfusion injury (IRI) after cardiopulmonary resuscitation (CPR) through neutrophil gelatinase-associated lipocalin (NGAL) and to explore effective monitoring of early renal injuries after CPR. Methods Thirty healthy minipigs were randomly divided into 3 groups: sham operation (SO) (n = 6), control (n = 12), and SFI (n = 12). The SO group underwent only catheterization, whereas the control and SFI groups were subjected to program-controlled electrical stimulation to establish a cardiac arrest (CA) model due to ventricular fibrillation. After CPR, the return of spontaneous circulation was achieved. Each animal in the SFI group was intravenously injected with SFI after resuscitation. Haemodynamic parameters were monitored at baseline and 2, 6, 12, and 24 hr after CPR. At each time point, venous blood samples were collected for NGAL, creatinine, and ATPase screening. Results After CA, the MAP, CPP, and CO of the animals in the control and SFI groups decreased significantly. However, at 6 hr after CPR, the MAP, CPP, and CO of the animals in the SFI group began to recover gradually; the differences between the control and SFI groups were significant (P < 0.005). The renal damage immediately after CPR appeared to be significant in the pathological examinations. However, the degree of renal injury in the SFI group improved significantly, and the apoptosis index was also notably reduced. The blood and urine NGAL levels were clearly elevated after CPR. The greatest increase in NGAL was found in the control group, which was significantly different from that of the SFI group (P < 0.001). SFI can significantly increase the ATPase activity of kidney tissues after CPR and improve abnormal caspase-3 protein expression. Conclusion SFI can effectively prevent acute kidney injuries caused by CPR through improving energy metabolism and inhibiting apoptosis.
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Wu J, Li Z, Yuan W, Zhao Y, Li J, Li Z, Li J, Li C. Changes of Endothelin-1 and Nitric Oxide Systems in Brain Tissue During Mild Hypothermia in a Porcine Model of Cardiac Arrest. Neurocrit Care 2019; 33:73-81. [PMID: 31595393 DOI: 10.1007/s12028-019-00855-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Our previous study found that mild hypothermia (MH) after resuscitation reduced cerebral microcirculation, but the mechanism was not elucidated. The aim of this study was to clarify changes of endothelin-1 (ET-1) and nitric oxide (NO) systems in brain tissue during hypothermia after resuscitation. METHODS Twenty-six domestic male Beijing Landrace pigs were used in this study. MH was intravascularly induced 1 h after resuscitation from 8-min ventricular fibrillation. Core temperature was reduced to 33 °C and maintained until 8 h after resuscitation, and then animals were euthanized. ET-1 and NO levels in brain tissue and peripheral plasma were measured. Expression of endothelin-converting enzyme-1 (ECE-1), endothelin A receptor (ET-AR), endothelin-B receptor, and nitric oxide synthase (NOS) in brain tissue was determined by Western blot analysis. RESULTS Compared with non-hypothermia (NH) treatment, MH after resuscitation significantly increased the level of endothelin-1 and reduced the level of NO in peripheral blood and brain tissue. Cerebral expression of ECE-1 and ET-AR was significantly increased during MH after resuscitation. Moreover, MH significantly decreased inducible NOS expression compared with the NH group. CONCLUSIONS The ET-1 system is activated, while inducible NOS is inhibited in brain tissue during MH after resuscitation.
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Affiliation(s)
- Junyuan Wu
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zhiwei Li
- Department of Neurology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, 100000, China
| | - Wei Yuan
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yongzhen Zhao
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jie Li
- Department of Emergency Medicine, Beijing Fuxing Hospital, Capital Medical University, Beijing, 100038, China
| | - Zhenhua Li
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Jiebin Li
- Department of Emergency Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Yuan W, Wu JY, Zhao YZ, Li J, Li JB, Li ZH, Li CS. Effects of Mild Hypothermia on Cardiac and Neurological Function in Piglets Under Pathological and Physiological Stress Conditions. Ther Hypothermia Temp Manag 2018; 9:136-145. [PMID: 30239278 DOI: 10.1089/ther.2018.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To investigate the different effects of mild hypothermia on pathological and physiological stress conditions in piglets, 30 pigs were randomized into four groups: cardiac arrest and mild hypothermia (CA-MH group), cardiac arrest and normothermia (CA-NH group), non-CA-MH (NCA-MH group), and a sham operation. The same hypothermia intervention was implemented in both CA-MH and NCA-MH groups. The CA-NH group did not undergo therapeutic hypothermia after resuscitation. The hemodynamic parameters were recorded. Cerebral metabolism variables and neurotransmitters in the extracellular fluid were collected through microdialysis tubes. The serum of venous blood was used to detect levels of inflammatory factors. The cerebral function was evaluated. At 24 and 72 hours after resuscitation, the cerebral performance category and neurological deficit score in the CA-NH group had higher values. Heart rate and cardiac output (CO) in the CA-MH group during cooling were lower than that of the CA-NH group, but CO was higher after rewarming. Glucose was higher during cooling, and extracellular lactate and lactate/pyruvate ratio in the CA-MH group were lower than that of the CA-NH group. Noradrenaline and 5-hydroxytryptamine in the CA-MH and NCA-MH groups were lower than that of the CA-NH group and sham group during cooling, respectively. Inflammatory factor levels, including interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, and tumor necrosis factor-α, in the CA-MH group were lower than that of the CA-NH group at cooling for 12 hours. These values in the NCA-MH group were higher than that of the sham group. Under a light and an electron microscope, the worse pathological results of heart and brain were observed in the two cardiac arrest groups. Mild hypothermia can provide limited organ protection in the specific pathological condition caused by ischemia-reperfusion, but it may produce a negative effect in a normal physiological state.
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Affiliation(s)
- Wei Yuan
- 1 Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, China
| | - Jun-Yuan Wu
- 1 Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, China
| | - Yong-Zhen Zhao
- 1 Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, China
| | - Jie Li
- 3 Department of Emergency, Beijing Fu-Xing Hospital, Capital Medical University, Beijing, China
| | - Jie-Bin Li
- 4 Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhen-Hua Li
- 5 Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chun-Sheng Li
- 1 Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,2 Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, China
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Xie Z, Yang Q, Li M, Huang Z, Wang Y, Ling Q, Tang W, Yang Z. Amplitude screening improves performance of AMSA method for predicting success of defibrillation in swine model. Am J Emerg Med 2018; 37:1224-1229. [PMID: 30194021 DOI: 10.1016/j.ajem.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/20/2018] [Accepted: 09/03/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE A novel amplitude screening method, termed Optimal Amplitude Spectrum Area (Opt-AMSA) with the aim of improving the performance of the Amplitude Spectrum Area (AMSA) method, was proposed to optimize the timing of defibrillation. We investigated the effects of the Opt-AMSA method on the prediction of successful defibrillation when compared with AMSA in a porcine model of ventricular fibrillation (VF). METHOD 60 male domestic pigs were untreated in the first 10 min of VF, then received cardiopulmonary resuscitation (CPR) for 6 min. Values of Opt-AMSA and AMSA were calculated every minute before defibrillation. Linear regression was used to evaluate the correlation between Opt-AMSA and AMSA. Receiver Operating Characteristic (ROC) analysis was conducted for the two methods and to compare their predictive values. RESULTS The values of both AMSA and Opt-AMSA gradually decreased over time during untreated VF in all animals. The values of both methods of defibrillation were slightly increased after the implementation of CPR in animals that were successfully resuscitated, while there were no significant changes in either method in those who ultimately failed to resuscitate. The significant positive correlation between Opt-AMSA and AMSA was shown by Pearson correlation analysis. ROC analysis showed that Opt-AMSA (AUC = 0.87) significantly improved the performance of AMSA (AUC = 0.77) to predict successful defibrillation (Z = 2.27, P < 0.05). CONCLUSION Both the Opt-AMSA and AMSA methods showed high potential to predict the success of defibrillation. Moreover, the Opt-AMSA method improved the performance of the AMSA method, and may be a promising tool to optimize the timing of defibrillation.
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Affiliation(s)
- Zhuoyan Xie
- School of Automation, GuangDong University of Technology, Guangzhou, China
| | - Qiyu Yang
- School of Automation, GuangDong University of Technology, Guangzhou, China
| | - Ming Li
- School of Automation, GuangDong University of Technology, Guangzhou, China
| | - Zhaolan Huang
- School of Automation, GuangDong University of Technology, Guangzhou, China
| | - Yue Wang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qin Ling
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; ZengCheng District People's Hospital of GuangZhou, Guangzhou, China
| | - Wanchun Tang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Weil Institute of Emergency and Critical Care Research, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
| | - Zhengfei Yang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; ZengCheng District People's Hospital of GuangZhou, Guangzhou, China; Weil Institute of Emergency and Critical Care Research, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
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Wollborn J, Ruetten E, Schlueter B, Haberstroh J, Goebel U, Schick MA. Standardized model of porcine resuscitation using a custom-made resuscitation board results in optimal hemodynamic management. Am J Emerg Med 2018; 36:1738-1744. [PMID: 29395757 DOI: 10.1016/j.ajem.2018.01.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/15/2023] Open
Abstract
AIM Standardized modeling of cardiac arrest and cardiopulmonary resuscitation (CPR) is crucial to evaluate new treatment options. Experimental porcine models are ideal, closely mimicking human-like physiology. However, anteroposterior chest diameter differs significantly, being larger in pigs and thus poses a challenge to achieve adequate perfusion pressures and consequently hemodynamics during CPR, which are commonly achieved during human resuscitation. The aim was to prove that standardized resuscitation is feasible and renders adequate hemodynamics and perfusion in pigs, using a specifically designed resuscitation board for a pneumatic chest compression device. METHODS AND RESULTS A "porcine-fit" resuscitation board was designed for our experiments to optimally use a pneumatic compression device (LUCAS® II, Physio-Control Inc.), which is widely employed in emergency medicine and ideal in an experimental setting due to its high standardization. Asphyxial cardiac arrest was induced in 10 German hybrid landrace pigs and cardiopulmonary resuscitation was performed according to ERC/AHA 2015 guidelines with mechanical chest compressions. Hemodynamics were measured in the carotid and pulmonary artery. Furthermore, arterial blood gas was drawn to assess oxygenation and tissue perfusion. The custom-designed resuscitation board in combination with the LUCAS® device demonstrated highly sufficient performance regarding hemodynamics during CPR (mean arterial blood pressure, MAP 46 ± 1 mmHg and mean pulmonary artery pressure, mPAP of 36 ± 1 mmHg over the course of CPR). MAP returned to baseline values at 2 h after ROSC (80 ± 4 mmHg), requiring moderate doses of vasopressors. Furthermore, stroke volume and contractility were analyzed using pulse contour analysis (106 ± 3 ml and 1097 ± 22 mmHg/s during CPR). Blood gas analysis revealed CPR-typical changes, normalizing in the due course. Thermodilution parameters did not show persistent intravascular volume shift. CONCLUSION Standardized cardiopulmonary resuscitation is feasible in a porcine model, achieving adequate hemodynamics and consecutive tissue perfusion of consistent quality.
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Affiliation(s)
- Jakob Wollborn
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Eva Ruetten
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Bjoern Schlueter
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Joerg Haberstroh
- Division of Experimental Surgery, Center for Experimental Models and Transgenic Services, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Martin A Schick
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Germany; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Charbonney E, Delisle S, Savary D, Bronchti G, Rigollot M, Drouet A, Badat B, Ouellet P, Gosselin P, Mercat A, Brochard L, Richard JCM. A new physiological model for studying the effect of chest compression and ventilation during cardiopulmonary resuscitation: The Thiel cadaver. Resuscitation 2018; 125:135-142. [PMID: 29317351 DOI: 10.1016/j.resuscitation.2018.01.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/03/2017] [Accepted: 01/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studying ventilation and intrathoracic pressure (ITP) induced by chest compressions (CC) during Cardio Pulmonary Resuscitation is challenging and important aspects such as airway closure have been mostly ignored. We hypothesized that Thiel Embalmed Cadavers could constitute an appropriate model. METHODS We assessed respiratory mechanics and ITP during CC in 11 cadavers, and we compared it to measurements obtained in 9 out-of-hospital cardiac arrest patients and to predicted values from a bench model. An oesophageal catheter was inserted to assess chest wall compliance, and ITP variation (ΔITP). Airway pressure variation (ΔPaw) at airway opening and ΔITP generated by CC were measured at decremental positive end expiratory pressure (PEEP) to test its impact on flow and ΔPaw. The patient's data were derived from flow and airway pressure captured via the ventilator during resuscitation. RESULTS Resistance and Compliance of the respiratory system were comparable to those of the out-of-hospital cardiac arrest patients (CRSTEC 42 ± 12 vs CRSPAT 37.3 ± 10.9 mL/cmH2O and ResTEC 17.5 ± 7.5 vs ResPAT 20.2 ± 5.3 cmH2O/L/sec), and remained stable over time. During CC, ΔITP varied from 32 ± 12 cmH2O to 69 ± 14 cmH2O with manual and automatic CC respectively. Transmission of ΔITP at the airway opening was significantly affected by PEEP, suggesting dynamic small airway closure at low lung volumes. This phenomenon was similarly observed in patients. CONCLUSION Respiratory mechanics and dynamic pressures during CC of cadavers behave as predicted by a theoretical model and similarly to patients. The Thiel model is a suitable to assess ITP variations induced by ventilation during CC.
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Affiliation(s)
- Emmanuel Charbonney
- Centre de Recherche de l 'Hôpital du Sacré-cœur de Montréal, Montreal, Canada; Département de médecine, Faculté de Médecine Université de Montréal, Montreal, Canada; Laboratoire d'anatomie, Université du Québec à Trois-Rivières (UQTR) et CIUSSS MCQ, Trois-Rivières, Canada.
| | - Stéphane Delisle
- Centre de Recherche du Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, Canada
| | - Dominique Savary
- SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France
| | - Gilles Bronchti
- Laboratoire d'anatomie, Université du Québec à Trois-Rivières (UQTR) et CIUSSS MCQ, Trois-Rivières, Canada
| | | | - Adrien Drouet
- SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France
| | | | - Paul Ouellet
- Vitalité Health Network, North West Zone, Edmundston and Department of surgery, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Alain Mercat
- Critical Care Department, Angers University Hospital, Angers, France
| | - Laurent Brochard
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute,St. Michael's Hospital, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Jean-Christophe M Richard
- SAMU74, Emergency Department, General Hospital of Annecy, Annecy, France; INSERM UMR 955, Créteil, France
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Yuan W, Wu JY, Zhao YZ, Li J, Li JB, Li ZH, Li CS. Effect of mild hypothermia on renal ischemia/reperfusion injury after cardiopulmonary resuscitation in a swine model. Acta Cir Bras 2017; 32:523-532. [PMID: 28793036 DOI: 10.1590/s0102-865020170070000003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/19/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose: To investigate the effect of intravascular cooling on renal function after resuscitation. Methods: Twenty four pigs were randomized into three groups (n=8 in each group): therapeutic hypothermia group (TH group), normothermia group (NH group) and sham operation group (SHAM group). After 6 minutes of untreated VF, CPR was performed. Upon ROSC, the TH group received the intravascular cooling. The NH and SHAM group did not undergo therapeutic hypothermia. Haemodynamic parameters were recorded. The bloods were analyzed for serum creatinine (sCr), CysC and NGAL. The kidney was surgically removed observe pathologic changes under a light microscope. Results: The sCr increased in both TH and NH groups after ROSC, compared to baseline. Between two groups, the sCr and creatinine clearance (Cc) showed lower level in the TH group. The urine volume per hour in the TH group were higher during cooling. After resuscitation, NGAL and CysC in the NH group were higher than in the TH group. Under the light microscope, compared with the TH group, the renal injury was prominent in the NH group. Conclusion: Mild hypothermia had a protection to renal ischemia reperfusion injury after resuscitation.
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Affiliation(s)
- Wei Yuan
- Master, Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. Conception and design of the study, acquisition and interpretation of data, manuscript writing
| | - Jun-Yuan Wu
- PhD, Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. Acquisition of data, critical revision
| | - Yong-Zhen Zhao
- Master, Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. Acquisition of data
| | - Jie Li
- Full Professor, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, China. Design and supervised all phases of the study, critical revision
| | - Jie-Bin Li
- Master, Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. Acquisition of data
| | - Zhen-Hua Li
- Master, Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. Acquisition of data
| | - Chun-Sheng Li
- Full Professor, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, China. Design and supervised all phases of the study, critical revision
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Yuan W, Wu JY, Zhao YZ, Li J, Li JB, Li ZH, Li CS. Comparison of early sequential hypothermia and delayed hypothermia on neurological function after resuscitation in a swine model. Am J Emerg Med 2017; 35:1645-1652. [PMID: 28521971 DOI: 10.1016/j.ajem.2017.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We utilized a porcine cardiac arrest model to compare early sequential hypothermia (ESH) with delayed hypothermia (DH) and no hypothermia (NH) to investigate the different effects on cerebral function after resuscitation. METHODS After return of spontaneous circulation (ROSC), resuscitated 24 pigs divided into three groups. The ESH group implemented early sequential hypothermia immediately, and the DH group implemented delayed hypothermia at 1 h after ROSC. The core temperature, hemodynamic parameters and oxygen metabolism were recorded. Cerebral metabolism variables and neurotransmitter in the extracellular fluid were collected through the microdialysis tubes. The bloods were analyzed for venous jugular bulb oxygen saturation, lactate and neuron specific nolase. The cerebral function was evaluated using the cerebral performance category and neurologic deficit score at 72h after ROSC and cerebral histology in the right posterior frontal lobe were collected. RESULTS ESH reached the target temperature earlier and showed more favorable outcomes of neurological function than DH. Specifically, early sequential hypothermia reduced cerebral oxygen and energy consumption and decreased extracellular accumulation of neurotransmitters after resuscitation and protected the integrity of the BBB during reperfusion. CONCLUSIONS Early sequential hypothermia could increase the protection of neurological function after resuscitation and produce better neurological outcomes. The institutional protocol number: 2010-D-013.
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Affiliation(s)
- Wei Yuan
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, China
| | - Jun-Yuan Wu
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, China
| | - Yong-Zhen Zhao
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, China
| | - Jie Li
- Department of Emergency, Beijing Fu-Xing Hospital, Capital Medical University, Beijing 100038, China
| | - Jie-Bin Li
- Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Zhen-Hua Li
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Chun-Sheng Li
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China; Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, China.
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Wu J, Yuan W, Li J, Zhao Y, Li J, Li Z, Li C. Effects of Mild Hypothermia on Cerebral Large and Small Microvessels Blood Flow in a Porcine Model of Cardiac Arrest. Neurocrit Care 2017; 27:297-303. [DOI: 10.1007/s12028-017-0395-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Ryu SJ, Lee SJ, Park CH, Lee SM, Lee DH, Cho YS, Jung YH, Lee BK, Jeung KW. Arterial pressure, end-tidal carbon dioxide, and central venous oxygen saturation in reflecting compression depth. Acta Anaesthesiol Scand 2016; 60:1012-23. [PMID: 27080141 DOI: 10.1111/aas.12728] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/03/2016] [Accepted: 03/06/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND We sought to investigate the utility of arterial pressure, end-tidal carbon dioxide (ETCO2 ), and central venous oxygen saturation (SCVO2 ) to guide compression depth adjustment. Thus, in a pig model of cardiac arrest, we observed these parameters during cardiopulmonary resuscitation (CPR) with optimal and suboptimal compression depths. METHODS Sixteen pigs underwent three experimental sessions after induction of ventricular fibrillation. First, the animals received two 4-min CPR trials with either optimal (20% of the anteroposterior diameter) or suboptimal (70% of the optimal depth) compression depth. Second, the animals received two 5-min CPR trials with optimal compression depth, in which adrenaline (0.02 mg/kg) or saline placebo was administered. Third, the animals randomly received compression with either optimal or suboptimal depth during advanced cardiovascular life support. RESULTS The systolic arterial pressure reflected compression depth most accurately and immediately (area under the curve [AUC], 0.895-0.939 without adrenaline and 0.928-1.000 with adrenaline). Although the response of ETCO2 to the change in compression depth was 0.5 min slower than that of the systolic arterial pressure, the performance of ETCO2 was comparable with that of systolic arterial pressure. SCVO2 did not reflect compression depth. Adrenaline administration remarkably increased systolic arterial pressure, diastolic arterial pressure, and coronary perfusion pressure but did not affect the ETCO2 readings. CONCLUSION In a pig model of cardiac arrest, systolic arterial pressure reflected compression depth immediately and accurately. The performance of ETCO2 was comparable with that of systolic arterial pressure. SCVO2 did not reflect compression depth.
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Affiliation(s)
- S-J. Ryu
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - S-J. Lee
- Department of Emergency Medicine; Myongji Hospital; Goyang Gyeonggi-do Korea
| | - C-H. Park
- Department of Emergency Medicine; Myongji Hospital; Goyang Gyeonggi-do Korea
| | - S-M. Lee
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - D-H. Lee
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - Y-S. Cho
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - Y-H. Jung
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - B-K. Lee
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
| | - K-W. Jeung
- Department of Emergency Medicine; Chonnam National University Hospital; Gwangju Korea
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Zhang Y, Li CS, Wu CJ, Yang J, Hang CC. Comparison of Cerebral Metabolism between Pig Ventricular Fibrillation and Asphyxial Cardiac Arrest Models. Chin Med J (Engl) 2016; 128:1643-8. [PMID: 26063367 PMCID: PMC4733747 DOI: 10.4103/0366-6999.158340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Morbidity and mortality after resuscitation largely depend on the recovery of brain function. Ventricular fibrillation cardiac arrest (VFCA) and asphyxial cardiac arrest (ACA) are the two most prevalent causes of sudden cardiac death. Up to now, most studies have focused on VFCA. However, results from the two models have been largely variable. So, it is necessary to characterize the features of postresuscitation cerebral metabolism of both models. METHODS Forty-four Wuzhishan miniature inbred pigs were randomly divided into three groups: 18 for VFCA group, ACA group, respectively, and other 8 for sham-operated group (SHAM). VFCA was induced by programmed electric stimulation, and ACA was induced by endotracheal tube clamping. After 8 min without treatment, standard cardiopulmonary resuscitation (CPR) was initiated. Following neurological deficit scores (NDS) were evaluated at 24 h after achievement of spontaneous circulation, cerebral metabolism showed as the maximum standardized uptake value (SUVmax) was measured by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography. Levels of serum markers of brain injury, neuron specific enolase (NSE), and S100β were quantified with an enzyme-linked immunosorbent assay. RESULTS Compared with VFCA group, fewer ACA animals achieved restoration of spontaneous circulation (61.1% vs. 94.4%, P < 0.01) and survived 24-h after resuscitation (38.9% vs. 77.8%, P < 0.01) with worse neurological outcome (NDS: 244.3 ± 15.3 vs. 168.8 ± 9.71, P < 0.01). The CPR duration of ACA group was longer than that of VFCA group (8.1 ± 1.2 min vs. 4.5 ± 1.1 min, P < 0.01). Cerebral energy metabolism showed as SUVmax in ACA was lower than in VFCA (P < 0.05 or P < 0.01). Higher serum biomarkers of brain damage (NSE, S100β) were found in ACA than VFCA after resuscitation (P < 0.01). CONCLUSIONS Compared with VFCA, ACA causes more severe cerebral metabolism injuries with less successful resuscitation and worse neurological outcome.
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Affiliation(s)
| | - Chun-Sheng Li
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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15
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Wu J, Li C, Yuan W. Effects of Shenfu injection on macrocirculation and microcirculation during cardiopulmonary resuscitation. JOURNAL OF ETHNOPHARMACOLOGY 2016; 180:97-103. [PMID: 26806577 DOI: 10.1016/j.jep.2016.01.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/21/2015] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Abstract
AIM OF THE STUDY To examine the effects of Shenfu injection (SFI) on macrocirculation and microcirculation during ventricular fibrillation (VF) and cardiopulmonary resuscitation (CPR). MATERIALS AND METHODS Sixteen female Landrace pigs were used in this study. After anesthesia, coronary perfusion pressure (CPP) was measured, and then the abdominal cavity was opened to observe the mesenteric microcirculation with the aid of sidestream dark field imaging. Following the guidelines, we determined microvascular flow index, perfused vessel density and proportion of perfused vessels both for large (diameter>20 μm) and small (diameter<20 μm) microvessels. SFI (1 ml/kg) or saline was given by vein injection at 1h before inducing VF. CPR was initiated after 4 min VF. RESULTS The shocks and duration of CPR were less in the SFI group compared with saline group. As the occurrence of VF, the CPP suddenly dropped to near zero, and cannot be measured in the both groups. However, there was greater CPP during CPR and at 1h after return of spontaneous circulation in the SFI group than saline group. Compared with saline, SFI significantly improved the microcirculation parameters of large and small microvessels during VF and CPR. CONCLUSIONS SFI can improve the microvascular blood flow and CPP during VF and CPR, and reduce the shocks and duration of CPR.
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Affiliation(s)
- Junyuan Wu
- Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No: BZ0370), Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020 China.
| | - Chunsheng Li
- Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No: BZ0370), Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020 China.
| | - Wei Yuan
- Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No: BZ0370), Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020 China.
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Wu J, Li C, Yuan W. Phosphodiesterase-5 inhibition improves macrocirculation and microcirculation during cardiopulmonary resuscitation. Am J Emerg Med 2016; 34:162-6. [DOI: 10.1016/j.ajem.2015.09.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/20/2015] [Accepted: 09/30/2015] [Indexed: 12/01/2022] Open
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Zhang Y, Li CS, Wu CJ, Yang J, Hang CC. Neuroprotective effect of Shenfu Injection () following cardiac arrest in pig correlates with improved mitochondrial function and cerebral glucose uptake. Chin J Integr Med 2014; 20:835-43. [PMID: 25411019 DOI: 10.1007/s11655-014-1890-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To test whether Shenfu Injection (, SFI) might attenuate the impact of cerebral energy dysfunction after resuscitation in a pig model of cardiac arrest (CA). METHODS Thirty-four Wuzhishan miniature inbred pigs were randomly divided into three groups: the SFI group (n=12), the saline group (SA group, n=12), and the sham-operated group (sham group, n=10). Following successful return of spontaneous circulation (ROSC) from 8-min untreated ventricular fibrillation, animals received a continuous infusion of either SFI (0.2 mL/min) or saline for 6 h. Cerebral performance category score was evaluated at 24 and 48 h after ROSC, followed by positron emission tomography and computed tomography scans of cerebral glucose uptake. Surviving pigs were euthanized 48 h after ROSC, and the brains were removed for detecting mitochondrial function. RESULTS Compared with the SA group, SFI treatment produced a better neurologic outcome 48 h after ROSC (P<0.05). However, there was no significant difference of survival rate between the SA and SFI groups (83.3% vs. 81.8%, P>0.05). After ROSC, the SA group showed a decrease in the maximum standardized uptake value of different regions in the brain tissue, where SFI treatment can ameliorate these decreases (P<0.01 or P<0.05). Improved mitochondrial respiratory properties and higher mitochondrial membrane potential were also found following SFI treatment compared with the SA group at 48 h after ROSC (P<0.05 or P<0.01). CONCLUSION SFI treatment after resuscitation has significant neuroprotective effects against disruption of cerebral energy metabolism from CA by improving glucose uptake and by normalizing mitochondrial function.
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Affiliation(s)
- Yi Zhang
- Department of Hyperbaric Oxygen, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
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Stiell IG, Brown SP, Nichol G, Cheskes S, Vaillancourt C, Callaway CW, Morrison LJ, Christenson J, Aufderheide TP, Davis DP, Free C, Hostler D, Stouffer JA, Idris AH. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? Circulation 2014; 130:1962-70. [PMID: 25252721 DOI: 10.1161/circulationaha.114.008671] [Citation(s) in RCA: 243] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 2010 American Heart Association guidelines suggested an increase in cardiopulmonary resuscitation compression depth with a target >50 mm and no upper limit. This target is based on limited evidence, and we sought to determine the optimal compression depth range. METHODS AND RESULTS We studied emergency medical services-treated out-of-hospital cardiac arrest patients from the Resuscitation Outcomes Consortium Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis clinical trial and the Epistry-Cardiac Arrest database. We calculated adjusted odds ratios for survival to hospital discharge, 1-day survival, and any return of circulation. We included 9136 adult patients from 9 US and Canadian cities with a mean age of 67.5 years, mean compression depth of 41.9 mm, and a return of circulation of 31.3%, 1-day survival of 22.8%, and survival to hospital discharge of 7.3%. For survival to discharge, the adjusted odds ratios were 1.04 (95% CI, 1.00-1.08) for each 5-mm increment in compression depth, 1.45 (95% CI, 1.20-1.76) for cases within 2005 depth range (>38 mm), and 1.05 (95% CI, 1.03-1.08) for percentage of minutes in depth range (10% change). Covariate-adjusted spline curves revealed that the maximum survival is at a depth of 45.6 mm (15-mm interval with highest survival between 40.3 and 55.3 mm) with no differences between men and women. CONCLUSIONS This large study of out-of-hospital cardiac arrest patients demonstrated that increased cardiopulmonary resuscitation compression depth is strongly associated with better survival. Our adjusted analyses, however, found that maximum survival was in the depth interval of 40.3 to 55.3 mm (peak, 45.6 mm), suggesting that the 2010 American Heart Association cardiopulmonary resuscitation guideline target may be too high. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00394706.
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Affiliation(s)
- Ian G Stiell
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.).
| | - Siobhan P Brown
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - Graham Nichol
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - Sheldon Cheskes
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - Christian Vaillancourt
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - Clifton W Callaway
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - Laurie J Morrison
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - James Christenson
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - Tom P Aufderheide
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - Daniel P Davis
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - Cliff Free
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - Dave Hostler
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - John A Stouffer
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
| | - Ahamed H Idris
- From the Department of Emergency Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (I.G.S., C.V.); Clinical Trials Center, Department of Biostatistics (S.P.B., G.N.) and Department of Medicine (G.N.), University of Washington, Seattle, WA; University of Washington-Harborview Center for Prehospital Emergency Care, Seattle, WA (G.N.); Division of Emergency Medicine, Department of Family and Community Medicine (S.C.), and Division of Emergency Medicine, Department of Medicine (L.J.M.), University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (S.C., L.J.M.); Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (C.W.C., D.H.); Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.C.); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (T.P.A.); Department of Emergency Medicine, University of California, San Diego, CA (D.P.D.); Camas Fire Department, Camas, WA (C.F.); Central Washington University, Ellensburg, WA (J.A.S.); Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX (A.H.I.)
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Lin QM, Fang XS, Zhou LL, Fu Y, Zhu J, Huang ZT. Changes of end-tidal carbon dioxide during cardiopulmonary resuscitation from ventricular fibrillation versus asphyxial cardiac arrest. World J Emerg Med 2014; 5:116-21. [PMID: 25215160 DOI: 10.5847/wjem.j.issn.1920-8642.2014.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 04/12/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Partial pressure of end-tidal carbon dioxide (PETCO2) has been used to monitor the effectiveness of precordial compression (PC) and regarded as a prognostic value of outcomes in cardiopulmonary resuscitation (CPR). This study was to investigate changes of PETCO2 during CPR in rats with ventricular fibrillation (VF) versus asphyxial cardiac arrest. METHODS Sixty-two male Sprague-Dawley (SD) rats were randomly divided into an asphyxial group (n=32) and a VF group (n=30). PETCO2 was measured during CPR from a 6-minute period of VF or asphyxial cardiac arrest. RESULTS The initial values of PETCO2 immediately after PC in the VF group were significantly lower than those in the asphyxial group (12.8±4.87 mmHg vs. 49.2±8.13 mmHg, P=0.000). In the VF group, the values of PETCO2 after 6 minutes of PC were significantly higher in rats with return of spontaneous circulation (ROSC), compared with those in rats without ROSC (16.5±3.07 mmHg vs. 13.2±2.62 mmHg, P=0.004). In the asphyxial group, the values of PETCO2 after 2 minutes of PC in rats with ROSC were significantly higher than those in rats without ROSC (20.8±3.24 mmHg vs. 13.9±1.50 mmHg, P=0.000). Receiver operator characteristic (ROC) curves of PETCO2 showed significant sensitivity and specificity for predicting ROSC in VF versus asphyxial cardiac arrest. CONCLUSIONS The initial values of PETCO2 immediately after CPR may be helpful in differentiating the causes of cardiac arrest. Changes of PETCO2 during CPR can predict outcomes of CPR.
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Affiliation(s)
- Qing-Ming Lin
- Department of Emergency Medicine, Fujian Provincial Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Xiang-Shao Fang
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China ; Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Li-Li Zhou
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China ; Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yue Fu
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China ; Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jun Zhu
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China ; Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zi-Tong Huang
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou 510120, China ; Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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Zhang Q, Li C. Combination of epinephrine with esmolol attenuates post-resuscitation myocardial dysfunction in a porcine model of cardiac arrest. PLoS One 2013; 8:e82677. [PMID: 24367539 PMCID: PMC3867387 DOI: 10.1371/journal.pone.0082677] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 10/26/2013] [Indexed: 11/19/2022] Open
Abstract
Background Recent experimental and clinical studies have indicated that the β-adrenergic effect of epinephrine significantly increases the severity of post resuscitation myocardial dysfunction. The aim of the study was to investigate whether the short-acting β1-selective adrenergic blocking agent, esmolol, would attenuate post resuscitation myocardial dysfunction in a porcine model of cardiac arrest. Methods and Results After 8 min of untreated ventricular fibrillation and 2 min of basic life support, 24 pigs were randomized to three groups (n = 8 per group), which received central venous injection of either epinephrine combined with esmolol (EE group), epinephrine (EP group), or saline (SA group). Hemodynamic status and blood samples were obtained at 0, 30, 60, 120, 240 and 360 min after return of spontaneous circulation (ROSC). Surviving pigs were euthanatized at 24 h after ROSC, and the hearts were removed for analysis by electron microscopy, Western blotting, quantitative real-time polymerase chain reaction, and terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling (TUNEL) assay. Compared with the EP and SA groups, EE group had a better outcome in hemodynamic function, (improved dp/dt maxima and minima and cardiac output) (P<0.05), and improved oxygen metabolism (oxygen delivery and oxygen consumption) (P<0.05), which suggesting that EE can protect myocardial tissue from injury and improve post-resuscitation myocardial dysfunction. The protective effect of EE also correlated with reducing cardiomyocyte apoptosis, evidenced by reducing TUNEL-positive cells, increasing anti-apoptotic Bcl-2/Bax ratio and suppression of caspase-3 activity in myocardium. Conclusions Esmolol, a short-acting β1-selective adrenergic blocking agent, given during CPR has significant effects on attenuating post resuscitation myocardial dysfunction. The current study provides a potential pharmacologic target for post resuscitation myocardial dysfunction.
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Affiliation(s)
- Qian Zhang
- Department of Emergency Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - ChunSheng Li
- Department of Emergency Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
- * E-mail:
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Even four minutes of poor quality of CPR compromises outcome in a porcine model of prolonged cardiac arrest. BIOMED RESEARCH INTERNATIONAL 2013; 2013:171862. [PMID: 24364028 PMCID: PMC3865628 DOI: 10.1155/2013/171862] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/09/2013] [Indexed: 11/29/2022]
Abstract
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.
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Yang Z, Li H, Yu T, Chen C, Xu J, Chu Y, Zhou T, Jiang L, Huang Z. Quality of chest compressions during compression-only CPR: a comparative analysis following the 2005 and 2010 American Heart Association guidelines. Am J Emerg Med 2013; 32:50-4. [PMID: 24210889 DOI: 10.1016/j.ajem.2013.09.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 09/28/2013] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The latest guidelines both increased the requirements of chest compression rate and depth during cardiopulmonary resuscitation (CPR), which may make it more difficult for the rescuer to provide high-quality chest compression. In this study, we investigated the quality of chest compressions during compression-only CPR under the latest 2010 American Heart Association (AHA) guidelines (AHA 2010) and its effect on rescuer fatigue. METHODS Eighty-six undergraduate volunteers were randomly assigned to perform CPR according to the 2005 AHA guidelines (AHA 2005) or AHA 2010. After the training course and theoretical examination of basic life support, eight min of compression-only CPR performance was assessed. The quality of chest compressions including rate and depth of compression was analyzed. The rescuer fatigue was evaluated by the changes of heart rate and blood lactate, and rating of perceived exertion. RESULTS Thirty-nine participants in the AHA 2005 group and 42 participants in the AHA 2010 group completed the study. Significantly greater mean chest compression depth and compression rate were both achieved in the AHA 2010 group than in the AHA 2005 group. And significantly greater rescuer fatigue was observed in the AHA 2010 group. In addition, the female in the AHA 2010 group could perform the compression rate required by the guidelines, however, significantly shallower compression depth and greater rescuer fatigue were observed when compared to the male. CONCLUSIONS The quality of chest compressions was significantly improved following the 2010 AHA guidelines, however, it's more difficult for the rescuer to meet the guidelines due to the increased fatigue of rescuer.
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Affiliation(s)
- Zhengfei Yang
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China.
| | - Heng Li
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China; Department of Emergency Medicine, Taiping People's Hospital, Medical School of Jinan University, Dongguan, China.
| | - Tao Yu
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China.
| | - Changwei Chen
- Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China; Department of Emergency Medicine, Taiping People's Hospital, Medical School of Jinan University, Dongguan, China.
| | - Jiefeng Xu
- Department of Emergency Medicine, Yuyao People's Hospital, Medical School of Ningbo University, Ningbo, China.
| | - Yueyong Chu
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China
| | - Tianen Zhou
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China.
| | - Longyuan Jiang
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China.
| | - Zitong Huang
- Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Institute of Cardiopulmonary Cerebral Resuscitation, Sun Yat-sen University, Guangzhou, China.
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Fox J, Fiechter R, Gerstl P, Url A, Wagner H, Lüscher TF, Eriksson U, Wyss CA. Mechanical versus manual chest compression CPR under ground ambulance transport conditions. ACTA ACUST UNITED AC 2013; 15:1-6. [PMID: 23425006 DOI: 10.3109/17482941.2012.735675] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Novel mechanical chest compression devices offer the possibility to transport cardiac arrest patients with ongoing CPR and might shorten significantly the time delay to post-resuscitation care. METHODS We simulated an eight-minute cardiac resuscitation situation during ambulance transport using CPR training manikins. We compared teams consisting of two experienced resuscitators with the performance of a mechanical chest compression device (LUCAS). RESULTS CPR-performance by two experienced resuscitators demonstrated ambivalent results. Whereas mean compression rate was within the recommended range (103/min, 95% CI: 93-113/min), mean compression depth was closely below the actually recommended compression depth of >5 cm (49.7 mm, 95% CI: 46.1-53.3mm). Nevertheless, only a mean of two thirds (67%) of all compressions were classified as manually correct (defined as sternal compression depth >5 cm). In contrast, the LUCAS device showed a constant and reliable CPR performance (99.96% correctly applied chest compressions correctly applied within the device programmed parameters, P = 0.0162) with almost no variance between the different sequences. CONCLUSION The LUCAS CPR device represents a reliable alternative to manual CPR in a moving ambulance vehicle during emergency evacuation. Furthermore, it needs less human resources and is safer for the EMS personnel.
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Affiliation(s)
- Julia Fox
- Hirslanden Accident and Emergency Center Zürich, Switzerland
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Effect of mild hypothermia on the coagulation-fibrinolysis system and physiological anticoagulants after cardiopulmonary resuscitation in a porcine model. PLoS One 2013; 8:e67476. [PMID: 23818980 PMCID: PMC3688589 DOI: 10.1371/journal.pone.0067476] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 05/19/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the effect of mild hypothermia on the coagulation-fibrinolysis system and physiological anticoagulants after cardiopulmonary resuscitation (CPR). A total of 20 male Wuzhishan miniature pigs underwent 8 min of untreated ventricular fibrillation and CPR. Of these, 16 were successfully resuscitated and were randomized into the mild hypothermia group (MH, n = 8) or the control normothermia group (CN, n = 8). Mild hypothermia (33°C) was induced intravascularly, and this temperature was maintained for 12 h before pigs were actively rewarmed. The CN group received normothermic post-cardiac arrest (CA) care for 72 h. Four animals were in the sham operation group (SO). Blood samples were taken at baseline, and 0.5, 6, 12, 24, and 72 h after ROSC. Whole-body mild hypothermia impaired blood coagulation during cooling, but attenuated blood coagulation impairment at 72 h after ROSC. Mild hypothermia also increased serum levels of physiological anticoagulants, such as PRO C and AT-III during cooling and after rewarming, decreased EPCR and TFPI levels during cooling but not after rewarming, and inhibited fibrinolysis and platelet activation during cooling and after rewarming. Finally, mild hypothermia did not affect coagulation-fibrinolysis, physiological anticoagulants, or platelet activation during rewarming. Thus, our findings indicate that mild hypothermia exerted an anticoagulant effect during cooling, which may have inhibitory effects on microthrombus formation. Furthermore, mild hypothermia inhibited fibrinolysis and platelet activation during cooling and attenuated blood coagulation impairment after rewarming. Slow rewarming had no obvious adverse effects on blood coagulation.
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Lee SH, Kim K, Lee JH, Kim T, Kang C, Park C, Kim J, Jo YH, Rhee JE, Kim DH. Does the quality of chest compressions deteriorate when the chest compression rate is above 120/min? Emerg Med J 2013; 31:645-8. [PMID: 23704754 DOI: 10.1136/emermed-2013-202682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The quality of chest compressions along with defibrillation is the cornerstone of cardiopulmonary resuscitation (CPR), which is known to improve the outcome of cardiac arrest. We aimed to investigate the relationship between the compression rate and other CPR quality parameters including compression depth and recoil. METHODS A conventional CPR training for lay rescuers was performed 2 weeks before the 'CPR contest'. CPR anytime training kits were distributed to respective participants for self-training on their own in their own time. The participants were tested for two-person CPR in pairs. The quantitative and qualitative data regarding the quality of CPR were collected from a standardised check list and SkillReporter, and compared by the compression rate. RESULTS A total of 161 teams consisting of 322 students, which includes 116 men and 206 women, participated in the CPR contest. The mean depth and rate for chest compression were 49.0±8.2 mm and 110.2±10.2/min. Significantly deeper chest compression depths were noted at rates over 120/min than those at any other rates (47.0±7.4, 48.8±8.4, 52.3±6.7, p=0.008). Chest compression depth was proportional to chest compression rate (r=0.206, p<0.001), but there were significantly more incomplete chest recoils at the rate of over 120/min than at any other rates (9.8%, 6.3%, 25.6%, p=0.011). CONCLUSIONS The study showed conflicting results in the quality of chest compression including chest compression depth and chest recoil by chest compression rate. Further evaluation regarding the upper limit of the chest compression rate is needed to ensure complete full chest wall recoil while maintaining an adequate chest compression depth.
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Affiliation(s)
- Soo Hoon Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Republic of Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Taeyun Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Republic of Korea
| | - Chanjong Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Joong Eui Rhee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Dong Hoon Kim
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Republic of Korea
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Yu J, Ramadeen A, Tsui AKY, Hu X, Zou L, Wilson DF, Esipova TV, Vinogradov SA, Leong-Poi H, Zamiri N, Mazer CD, Dorian P, Hare GMT. Quantitative assessment of brain microvascular and tissue oxygenation during cardiac arrest and resuscitation in pigs. Anaesthesia 2013; 68:723-35. [PMID: 23590519 DOI: 10.1111/anae.12227] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2013] [Indexed: 01/18/2023]
Abstract
Cardiac arrest is associated with a very high rate of mortality, in part due to inadequate tissue perfusion during attempts at resuscitation. Parameters such as mean arterial pressure and end-tidal carbon dioxide may not accurately reflect adequacy of tissue perfusion during cardiac resuscitation. We hypothesised that quantitative measurements of tissue oxygen tension would more accurately reflect adequacy of tissue perfusion during experimental cardiac arrest. Using oxygen-dependent quenching of phosphorescence, we made measurements of oxygen in the microcirculation and in the interstitial space of the brain and muscle in a porcine model of ventricular fibrillation and cardiopulmonary resuscitation. Measurements were performed at baseline, during untreated ventricular fibrillation, during resuscitation and after return of spontaneous circulation. After achieving stable baseline brain tissue oxygen tension, as measured using an Oxyphor G4-based phosphorescent microsensor, ventricular fibrillation resulted in an immediate reduction in all measured parameters. During cardiopulmonary resuscitation, brain oxygen tension remained unchanged. After the return of spontaneous circulation, all measured parameters including brain oxygen tension recovered to baseline levels. Muscle tissue oxygen tension followed a similar trend as the brain, but with slower response times. We conclude that measurements of brain tissue oxygen tension, which more accurately reflect adequacy of tissue perfusion during cardiac arrest and resuscitation, may contribute to the development of new strategies to optimise perfusion during cardiac resuscitation and improve patient outcomes after cardiac arrest.
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Affiliation(s)
- J Yu
- Departments of Anaesthesia and Physiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Wallace SK, Abella BS, Becker LB. Quantifying the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2013; 6:148-56. [PMID: 23481533 DOI: 10.1161/circoutcomes.111.000041] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background- Evidence has accrued that cardiopulmonary resuscitation quality affects cardiac arrest outcome. However, the relative contributions of chest compression components (such as rate and depth) to successful resuscitation remain unclear. Methods and Results- We sought to measure the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome through systematic review and meta-analysis. We searched for any clinical study assessing cardiopulmonary resuscitation performance on adult cardiac arrest patients in which survival was a reported outcome, either return of spontaneous circulation or survival to admission or discharge. Of 603 identified abstracts, 10 studies met inclusion criteria. Effect sizes were reported as mean differences. Missing data were resolved by author contact. Estimates were segregated by cardiopulmonary resuscitation metric (chest compression rate, depth, no-flow fraction, and ventilation rate), and a random-effects model was applied to estimate an overall pooled effect. Arrest survivors were significantly more likely to have received deeper chest compressions than nonsurvivors (mean difference, 2.44 mm; 95% confidence interval, 1.19-3.69 [P<0.001]; n=6 studies; I(2)=0.0%; P for heterogeneity=0.9). Likewise, survivors were significantly more likely to have received chest compression rates closer to 85 to 100 compressions per minute (cpm) than nonsurvivors (absolute mean difference from 85 cpm, -4.81 cpm; 95% confidence interval, -8.19 to -1.43 [P=0.005]; from 100 cpm, -5.04 cpm; 95% confidence interval, -8.44 to -1.65 [P=0.004]; n=6 studies; I(2)<49%; P for heterogeneity >0.2). No significant difference in no-flow fraction (n=7 studies) or ventilation rate (n=4 studies) was detected between survivors and nonsurvivors. Conclusions- Deeper chest compressions and rates closer to 85 to 100 cpm are significantly associated with improved survival from cardiac arrest.
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Affiliation(s)
- Sarah K Wallace
- Center for Resuscitation Science and Department of Emergency Medicine and the Doris Duke Clinical Research Fellowship Program, University of Pennsylvania, Philadelphia
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Effect of rescue breathing during cardiopulmonary resuscitation on lung function after restoration of spontaneous circulation in a porcine model of prolonged cardiac arrest. Crit Care Med 2013; 41:102-10. [PMID: 23269128 DOI: 10.1097/ccm.0b013e318265792b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The destruction of the pulmonary structure after cardiopulmonary resuscitation may lead to lung function breakdown. The aim of this study was to investigate lung function after cardiopulmonary resuscitation and the influence of rescue breathing on lung function. DESIGN Prospective, randomized animal study. SETTING A university animal research laboratory. SUBJECTS Twenty-eight male domestic pigs weighing 30 ± 2 kg. INTERVENTIONS The animals were randomized into three groups: continuous compressions (n = 12), 30:2 compression/rescue ventilation cardiopulmonary resuscitation (n = 12), and sham cardiopulmonary resuscitation (n = 4). Ventricular fibrillation was induced in the continuous compressions and compression/rescue ventilation groups. MEASUREMENTS AND MAIN RESULTS Cardiac output, extravascular lung water, and airway resistance were measured at baseline and 1, 2, and 4 hrs after restoration of spontaneous circulation. Thoracopulmonary compliance, lower inflection point, and dead space were calculated. Lung ventilation/perfusion scans with Tc were performed 48 hrs before the experiment and 24 hrs after restoration of spontaneous circulation. Conventional histopathology evaluation was performed. Dead space, airway resistance, lower inflection point, and extravascular lung water significantly increased and compliance decreased after restoration of spontaneous circulation in the continuous compressions and compression/rescue ventilation groups. Lung injury was more severe in the continuous compressions group. Significant differences were found between the two groups in the three time points after restoration of spontaneous circulation (p < 0.05). Variables of the sham cardiopulmonary resuscitation group remained stable during the whole protocol. Poor ventilation/perfusion and mismatch were found after restoration of spontaneous circulation, but the injury was mitigated in the compression/rescue ventilation group. Histopathology injury in the compression/rescue ventilation group was also improved. CONCLUSIONS Appropriate rescue breathing during cardiopulmonary resuscitation does not influence the prognosis of cardiac arrest or the hemodynamics after restoration of spontaneous circulation but can improve lung function and alleviate lung injury.
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Effects of hypothermia on brain injury assessed by magnetic resonance imaging after cardiopulmonary resuscitation in a porcine model of cardiac arrest. Am J Emerg Med 2013; 31:86-93. [DOI: 10.1016/j.ajem.2012.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 06/17/2012] [Accepted: 06/19/2012] [Indexed: 11/19/2022] Open
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Gu W, Li C, Yin W, Guo Z, Hou X, Zhang D. Shen-fu injection reduces postresuscitation myocardial dysfunction in a porcine model of cardiac arrest by modulating apoptosis. Shock 2012; 38:301-6. [PMID: 22683733 DOI: 10.1097/shk.0b013e31825f6632] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Shen-Fu injection (SFI) following cardiac arrest exhibits cardioprotective effects, but its effect on myocardial dysfunction, a critical issue following resuscitation, is unclear. This study sought to examine whether SFI reduces postresuscitation myocardial dysfunction in a porcine model of cardiac arrest by modulating apoptosis. After 8 min of untreated ventricular fibrillation and 2 min of basic life support, 24 pigs were randomized divided into three groups, which received central venous injection of either Shen-Fu (SFI group; 1.0 mL/kg), epinephrine (EP group; 0.02 mg/kg), or saline (SA group). After successful return of spontaneous circulation (ROSC), hemodynamic status and blood samples were obtained at 0, 30, 120, and 360 min after ROSC. Surviving pigs were killed at 24 h after ROSC, and the hearts were removed for analysis by electron microscopy, Western blotting, quantitative real-time polymerase chain reaction, and TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling) assay. Compared with the EP and SA groups, animals treated with SFI had improved left ventricular function (P < 0.05), lower troponin T levels (P < 0.01), and increased tissue perfusion and oxygen metabolism (P < 0.05). Shen-Fu injection was associated with a reduction in (i) Bcl-2, Bax, and caspase 3 protein expression (P < 0.05); (ii) caspase 3 mRNA upregulation; and (iii) apoptosis, compared with the EP and SA groups. Caspase 3-mediated apoptosis occurs following myocardial injury after cardiopulmonary resuscitation in pigs. Shen-Fu injection decreased myocardial injury; improved myocardial ultrastructure; inhibited Bcl-2, Bax, and caspase 3 expression; and reduced myocardial apoptosis. Therefore, SFI could significantly attenuate postresuscitation myocardial dysfunction by modulating apoptosis.
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Affiliation(s)
- Wei Gu
- Department of emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Apoptosis is involved in the mechanism of postresuscitation myocardial dysfunction in a porcine model of cardiac arrest. Am J Emerg Med 2012; 30:2039-45. [DOI: 10.1016/j.ajem.2012.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 11/19/2022] Open
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Wang S, Wu JY, Li CS. Load-distributing band improves ventilation and hemodynamics during resuscitation in a porcine model of prolonged cardiac arrest. Scand J Trauma Resusc Emerg Med 2012; 20:59. [PMID: 22938018 PMCID: PMC3492085 DOI: 10.1186/1757-7241-20-59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 08/25/2012] [Indexed: 11/10/2022] Open
Abstract
Background The use of mechanical cardiopulmonary resuscitation (CPR) has great potential for the clinical setting. The purpose of present study is to compare the hemodynamics and ventilation during and after the load-distributing band CPR, versus the manual CPR in a porcine model of prolonged cardiac arrest, and to investigate the influence of rescue breathing in different CPR protocols. Methods Sixty-four male pigs (n = 16/group), weighing 30 ± 2 kg, were induced ventricular fibrillation and randomized into four resuscitation groups: continuous load-distributing band CPR without rescue ventilation (C-CPR), load-distributing band 30:2 CPR (A-CPR), load-distributing band CPR with continuous rescue breathing (10/min) (V-CPR) or manual 30:2 CPR (M-CPR). Respiratory variables and hemodynamics were recorded continuously; blood gas was analyzed. Results Tidal volume produced by compressions in the A-, C- and V-CPR groups were significantly higher compared with the M-CPR group (all p < 0.05). Coronary perfusion pressure of the V-CPR group was significantly lower than the C-CPR group (p < 0.01), but higher than the M-CPR group. The increasing of lung dead space after restoration of spontaneous circulation was significantly greater in the M-CPR group compared with the A-, C- and V-CPR groups (p < 0.01). Blood pH gradually decreased and was lower in the M-CPR group than that in the A-, C- and V-CPR groups (p < 0.01). PaO2 of the A-, C- and V-CPR groups were significantly higher and PaCO2 were significantly lower compared with the M-CPR (both p < 0.05). Cerebral performance categories were better in the A-, C- and V-CPR groups compared with the M-CPR group (p < 0.0001). Conclusions The load-distributing band CPR significantly improved respiratory parameters during resuscitation by augmenting passive ventilation, and significantly improved coronary perfusion pressure. The volume of ventilation produced by the load-distributing band CPR was adequate to maintain sufficient gas exchange independent of rescue breathing.
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Affiliation(s)
- Shuo Wang
- Department of Emergency Medicine, Beijing Chaoyang Hospital, Affiliated to Capital Medical University, Chaoyang District, Beijing 100020, China
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Yuan W, Wang S, Li CS. The effects of 3 different compression methods on intrathoracic pressure in a swine model of ventricular fibrillation. Am J Emerg Med 2012; 31:100-7. [PMID: 22944535 DOI: 10.1016/j.ajem.2012.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 05/22/2012] [Accepted: 06/15/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to provide a realistic comparison of 3 different extracorporeal compression methods during cardiopulmonary resuscitation on intrathoracic pressure (ITP), hemodynamics, and oxygen metabolism in a swine model of ventricular fibrillation (VF). METHODS Eight minutes after the development of VF, pigs were subjected to 3 different extracorporeal compression methods: traditional artificial manual compression, mechanical compression using an AutoPulse apparatus, or manual sucker. Heart rhythm was assessed by electrocardiography after 5 cycles of extracorporeal compression. If VF still occurred, electrical defibrillation was performed. After defibrillation, an additional 5 cycles of extracorporeal compression were performed. Resuscitation was considered to have failed if the above procedure was continued for 30 minutes without return of spontaneous circulation. Hemodynamics and ITP waveforms were monitored continuously. Oxygen metabolism indices were measured, and success rates were compared among the groups. RESULTS Manual compression showed advantages over both of the other methods in terms of maximal ITP and fluctuation amplitude, hemodynamic and oxygen dynamic changes, convenience of administration, and duration of treatment. Survival rates and cerebral performance category scores for the manual compression group were significantly higher than that for the other groups. CONCLUSIONS Mechanical compression cannot replace traditional artificial manual compression, which remains the preferred method for cardiopulmonary resuscitation.
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Affiliation(s)
- Wei Yuan
- Beijing Chao-Yang Hospital, Affiliated to Capital Medical University, Beijing, China
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Infusion of 4°C normal saline can improve the neurological outcome in a porcine model of cardiac arrest. J Trauma Acute Care Surg 2012; 72:1213-9; discussion 1219. [PMID: 22673247 DOI: 10.1097/ta.0b013e318246ed36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study sought to investigate induction of therapeutic hypothermia using ice-cold intravenous fluid after cardiopulmonary resuscitation (CPR). The effects on temperature, hemodynamics, cognitive performance and the accompanying neurohistopathological changes, and apoptosis were assessed. METHODS Fourteen piglets had 4 minutes of untreated ventricular fibrillation, followed by CPR. The animals in which spontaneous circulation was restored were randomly assigned to two groups: the hypothermia group (n = 7) was given an infusion of 4°C cold normal saline solution 30 mL/kg at an infusion rate of 1.33 mL/kg/min, followed by 10 mL/kg/h to 4 hours after restoration of spontaneous circulation; the control group (n = 7) was given the same infusion at room temperature. Variables were measured repeatedly until 4 hours after restoration of spontaneous circulation. Neurocognitive performance was evaluated 24 hours after CPR. Then animals were killed and the brains were removed for histopathology at 24 hours after restoration of spontaneous circulation. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling method was used for apoptosis evaluation. RESULTS Compared with the control group, the core temperature of the hypothermia group was significantly decreased (p < 0.01). The cerebral performance categories at 24 hours after restoration of spontaneous circulation in the hypothermia group were better than that in the control group (p < 0.05). The percentage of terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling-positive cells in the cortex and dentate gyrus of the hippocampus were significantly reduced in the hypothermia group compared with the control group at 24 hours after restoration of spontaneous circulation. By observation of transmission electron microscopy, the neuron damages were significantly reduced in hypothermia group. CONCLUSION 4°C normal saline solution is a safe and effective method to reduce brain damages and prevent apoptotic cell death after cardiac arrest.
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What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012; 40:1192-8. [PMID: 22202708 DOI: 10.1097/ccm.0b013e31823bc8bb] [Citation(s) in RCA: 318] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The 2010 international guidelines for cardiopulmonary resuscitation recently recommended an increase in the minimum compression depth from 38 to 50 mm, although there are limited human data to support this. We sought to study patterns of cardiopulmonary resuscitation compression depth and their associations with patient outcomes in out-of-hospital cardiac arrest cases treated by the 2005 guideline standards. DESIGN Prospective cohort. SETTING Seven U.S. and Canadian urban regions. PATIENTS We studied emergency medical services treated out-of-hospital cardiac arrest patients from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest for whom electronic cardiopulmonary resuscitation compression depth data were available, from May 2006 to June 2009. MEASUREMENTS We calculated anterior chest wall depression in millimeters and the period of active cardiopulmonary resuscitation (chest compression fraction) for each minute of cardiopulmonary resuscitation. We controlled for covariates including compression rate and calculated adjusted odds ratios for any return of spontaneous circulation, 1-day survival, and hospital discharge. MAIN RESULTS We included 1029 adult patients from seven U.S. and Canadian cities with the following characteristics: Mean age 68 yrs; male 62%; bystander witnessed 40%; bystander cardiopulmonary resuscitation 37%; initial rhythms: Ventricular fibrillation/ventricular tachycardia 24%, pulseless electrical activity 16%, asystole 48%, other nonshockable 12%; outcomes: Return of spontaneous circulation 26%, 1-day survival 18%, discharge 5%. For all patients, median compression rate was 106 per minute, median compression fraction 0.65, and median compression depth 37.3 mm with 52.8% of cases having depth <38 mm and 91.6% having depth <50 mm. We found an inverse association between depth and compression rate ( p < .001). Adjusted odds ratios for all depth measures (mean values, categories, and range) showed strong trends toward better outcomes with increased depth for all three survival measures. CONCLUSIONS We found suboptimal compression depth in half of patients by 2005 guideline standards and almost all by 2010 standards as well as an inverse association between compression depth and rate. We found a strong association between survival outcomes and increased compression depth but no clear evidence to support or refute the 2010 recommendations of >50 mm. Although compression depth is an important component of cardiopulmonary resuscitation and should be measured routinely, the most effective depth is currently unknown.
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Gong P, Li CS, Hua R, Zhao H, Tang ZR, Mei X, Zhang MY, Cui J. Mild hypothermia attenuates mitochondrial oxidative stress by protecting respiratory enzymes and upregulating MnSOD in a pig model of cardiac arrest. PLoS One 2012; 7:e35313. [PMID: 22532848 PMCID: PMC3332059 DOI: 10.1371/journal.pone.0035313] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 03/13/2012] [Indexed: 01/22/2023] Open
Abstract
Mild hypothermia is the only effective treatment confirmed clinically to improve neurological outcomes for comatose patients with cardiac arrest. However, the underlying mechanism is not fully elucidated. In this study, our aim was to determine the effect of mild hypothermia on mitochondrial oxidative stress in the cerebral cortex. We intravascularly induced mild hypothermia (33°C), maintained this temperature for 12 h, and actively rewarmed in the inbred Chinese Wuzhishan minipigs successfully resuscitated after 8 min of untreated ventricular fibrillation. Cerebral samples were collected at 24 and 72 h following return of spontaneous circulation (ROSC). We found that mitochondrial malondialdehyde and protein carbonyl levels were significantly increased in the cerebral cortex in normothermic pigs even at 24 h after ROSC, whereas mild hypothermia attenuated this increase. Moreover, mild hypothermia attenuated the decrease in Complex I and Complex III (i.e., major sites of reactive oxygen species production) activities of the mitochondrial respiratory chain and increased antioxidant enzyme manganese superoxide dismutase (MnSOD) activity. This increase in MnSOD activity was consistent with the upregulation of nuclear factor erythroid 2-related factor 2 (Nrf2) mRNA and protein expressions, and with the increase of Nrf2 nuclear translocation in normothermic pigs at 24 and 72 h following ROSC, whereas mild hypothermia enhanced these tendencies. Thus, our findings indicate that mild hypothermia attenuates mitochondrial oxidative stress in the cerebral cortex, which may be associated with reduced impairment of mitochondrial respiratory chain enzymes, and enhancement of MnSOD activity and expression via Nrf2 activation.
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Affiliation(s)
- Ping Gong
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chun-Sheng Li
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Rong Hua
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hong Zhao
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zi-Ren Tang
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xue Mei
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ming-Yue Zhang
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Juan Cui
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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Niles DE, Nishisaki A, Sutton RM, Nysæther J, Eilevstjønn J, Leffelman J, Maltese MR, Arbogast KB, Abella BS, Helfaer MA, Berg RA, Nadkarni VM. Comparison of relative and actual chest compression depths during cardiac arrest in children, adolescents, and young adults. Resuscitation 2011; 83:320-6. [PMID: 22079410 DOI: 10.1016/j.resuscitation.2011.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 10/17/2011] [Accepted: 10/24/2011] [Indexed: 11/28/2022]
Abstract
AIM Cardiopulmonary resuscitation (CPR) guidelines recommend specific chest compression (CC) target depths for children. We quantitatively describe relative anterior-posterior diameter (APD) depth, actual depth, and force of CCs during real CPR events in children. METHODS CC depth and force were recorded during real CPR events in children ≥8 years using FDA-approved CC sensor. Patient chest APD was measured at conclusion of each CPR event. CC data was stratified and analyzed according to age (pre-puberty, 8-14 years; post-puberty, 15+ years). Relative (% APD) and actual CC depth, corrected for mattress deflection, were assessed and compared with American Heart Association (AHA) 2005 and 2010 pediatric CPR guidelines. RESULTS 35 events in 32 subjects included 16,158 CCs for data analysis: 16 pre-puberty (CCs=7484, age 11.9±2 years, APD 164.6±25.1 mm); 19 post-puberty (CCs=8674, age 18.0±2.7 years, APD 196.5±30.4 mm). After correction for mattress deflection, 92% of CC delivered to pre-puberty were <1/3 relative APD and 60% of CC were <38 mm actual depth. Mean actual CC depth (36.2±9.6 mm vs. 36.8±9.9 mm, p=0.64), mean relative APD (22.5%±7.0% vs. 19.5±6.7%, p=0.13), and mean CC force (30.7±7.6 kg vs. 33.6±9.4 kg, p=0.07) were not significantly less in pre-puberty vs. post-puberty. CONCLUSIONS During in-hospital cardiac arrest of children ≥8 years, CCs delivered by resuscitation teams were frequently <1/3 relative APD and <38 mm actual depth after mattress deflection correction, below pediatric and adult target guidelines. Mean CC actual depth and force were not significantly different in pre-puberty and post-puberty. Additional investigation to determine depth of CCs to optimize hemodynamics and outcomes is needed to inform future CPR guidelines.
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Affiliation(s)
- Dana E Niles
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, USA.
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Koster RW, Sayre MR, Botha M, Cave DM, Cudnik MT, Handley AJ, Hatanaka T, Hazinski MF, Jacobs I, Monsieurs K, Morley PT, Nolan JP, Travers AH. Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2011; 81 Suppl 1:e48-70. [PMID: 20956035 DOI: 10.1016/j.resuscitation.2010.08.005] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands.
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Sayre MR, Koster RW, Botha M, Cave DM, Cudnik MT, Handley AJ, Hatanaka T, Hazinski MF, Jacobs I, Monsieurs K, Morley PT, Nolan JP, Travers AH. Part 5: Adult basic life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S298-324. [PMID: 20956253 DOI: 10.1161/circulationaha.110.970996] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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