Document Detail


Hemodynamic directed CPR improves short-term survival from asphyxia-associated cardiac arrest.
MedLine Citation:
PMID:  23142199     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: Adequate coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR) is essential for establishing return of spontaneous circulation. The objective of this study was to compare short-term survival using a hemodynamic directed resuscitation strategy versus an absolute depth-guided approach in a porcine model of asphyxia-associated cardiac arrest. We hypothesized that a hemodynamic directed approach would improve short-term survival compared to depth-guided care.
METHODS: After 7 min of asphyxia, followed by induction of ventricular fibrillation, 19 female 3-month old swine (31±0.4 kg) were randomized to receive one of three resuscitation strategies: (1) hemodynamic directed care (CPP-20): chest compressions (CCs) with depth titrated to a target systolic blood pressure of 100 mmHg and titration of vasopressors to maintain CPP>20 mmHg; (2) depth 33 mm (D33): target CC depth of 33 mm with standard American Heart Association (AHA) epinephrine dosing; or (3) depth 51 mm (D51): target CC depth of 51 mm with standard AHA epinephrine dosing. All animals received manual CPR guided by audiovisual feedback for 10 min before first shock.
RESULTS: 45-Min survival was higher in the CPP-20 group (6/6) compared to D33 (1/7) or D51 (1/6) groups; p=0.002. Coronary perfusion pressures were higher in the CPP-20 group compared to D33 (p=0.011) and D51 (p=0.04), and in survivors compared to non-survivors (p<0.01). Total number of vasopressor doses administered and defibrillation attempts were not different.
CONCLUSIONS: Hemodynamic directed care targeting CPPs>20 mmHg improves short-term survival in an intensive care unit porcine model of asphyxia-associated cardiac arrest.
Authors:
Robert M Sutton; Stuart H Friess; Utpal Bhalala; Matthew R Maltese; Maryam Y Naim; George Bratinov; Dana Niles; Vinay M Nadkarni; Lance B Becker; Robert A Berg
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-11-07
Journal Detail:
Title:  Resuscitation     Volume:  84     ISSN:  1873-1570     ISO Abbreviation:  Resuscitation     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-29     Completed Date:  2013-12-17     Revised Date:  2014-05-08    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  696-701     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Animals
Asphyxia / physiopathology,  therapy*
Cardiopulmonary Resuscitation / methods*
Coronary Circulation / physiology*
Female
Heart Arrest / physiopathology,  therapy*
Hemodynamics
Survival Rate
Swine
Grant Support
ID/Acronym/Agency:
K08 NS064051/NS/NINDS NIH HHS; K23 HD062629/HD/NICHD NIH HHS
Comments/Corrections

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