Reperfusion injury protection during Basic Life Support improves circulation and survival outcomes in a porcine model of prolonged cardiac arrest

• Published in: Resuscitation Vol. 105; pp. 29 - 35
• Main Authors: Debaty, Guillaume, Lurie, Keith, Metzger, Anja, Lick, Michael, Bartos, Jason A., Rees, Jennifer N., McKnite, Scott, Puertas, Laura, Pepe, Paul, Fowler, Raymond, Yannopoulos, Demetris
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.08.2016; Elsevier
• Subjects: Active compression decompression; Animals; Basic life support; Blood Circulation; Cardiac arrest; Cardiology and cardiovascular system; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - mortality; Disease Models, Animal; Electric Countershock - methods; Emergency; Epinephrine - administration & dosage; Female; Heart Arrest - mortality; Heart Arrest - therapy; Human health and pathology; Impedance threshold device; Ischemic postconditioning; Ischemic Postconditioning - methods; Life Sciences; Prospective Studies; Random Allocation; Reperfusion Injury - prevention & control; Swine; Sympathomimetics - administration & dosage; Time Factors; Impedance threshold device; Basic life support; Ischemic postconditioning; Cardiopulmonary resuscitation; Cardiac arrest; Active compression decompression
• DOI: 10.1016/j.resuscitation.2016.05.008
• ISSN: 0300-9572

Ischemic postconditioning (PC) using three intentional pauses at the start of cardiopulmonary resuscitation (CPR) improves outcomes after cardiac arrest in pigs when epinephrine (epi) is used before defibrillation. We hypothesized PC, performed during basic life support (BLS) in the absence of epinephrine, would reduce reperfusion injury and enhance 24h functional recovery. Prospective animal investigation. Animal laboratory Female farm pigs (n=46, 39±1kg). Protocol A: After 12min of ventricular fibrillation (VF), 28 pigs were randomized to four groups: (A) Standard CPR (SCPR), (B) active compression-decompression CPR with an impedance threshold device (ACD-ITD), (C) SCPR+PC (SCPR+PC) and (D) ACD-ITD CPR+PC. Protocol B: After 15min of VF, 18 pigs were randomized to ACD-ITD CPR or ACD-ITD+PC. The BLS duration was 2.75min in Protocol A and 5min in Protocol B. Following BLS, up to three shocks were delivered. Without return of spontaneous circulation (ROSC), CPR was resumed and epi (0.5mg) and defibrillation delivered. The primary end point was survival without major adverse events. Hemodynamic parameters and left ventricular ejection fraction (LVEF) were also measured. Data are presented as mean±SEM. Protocol A: ACD-ITD+PC (group D) improved coronary perfusion pressure after 3min of BLS versus the three other groups (28±6, 35±7, 23±5 and 47±7 for groups A, B, C, D respectively, p=0.05). There were no significant differences in 24h survival between groups. LVEF 4h post ROSC was significantly higher with ACD-ITD+PC vs ACD-ITD alone (52.5±3% vs. 37.5±6.6%, p=0.045). Survival rates were significantly higher with ACD-ITD+PC vs. ACD-ITD alone (p=0.027). BLS using ACD-ITD+PC reduced post resuscitation cardiac dysfunction and improved functional recovery after prolonged untreated VF in pigs. 12-11.