Document Detail


Increasing CPR duration prior to first defibrillation does not improve return of spontaneous circulation or survival in a swine model of prolonged ventricular fibrillation.
MedLine Citation:
PMID:  18620793     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The optimum duration of cardiopulmonary resuscitation (CPR) prior to first rescue shock is unknown. Clinical trials have used 90 and 180 s. Neither of these durations may be optimal. We sought to determine the optimum duration of CPR prior to first defibrillation attempt and whether this varied depending on the duration of ventricular fibrillation (VF). In this porcine model of basic life support, our outcomes were rates of return of spontaneous circulation (ROSC), survival, and coronary perfusion pressure (CPP). METHODS: We anesthetized and instrumented 45 swine and then induced VF. After 5 or 8 min of untreated VF, we randomized the swine to mechanical CPR for 90, 180, or 300 s. A single rescue shock (150 J biphasic) was then administered. If this shock failed, 2 min of mechanical CPR were completed prior to the next rescue shock. CPP was calculated for each 30s epoch. ROSC was defined as a blood pressure >80 mmHg sustained for 60s. Survival was defined as sustained ROSC for 20 min. Data were analyzed with descriptive statistics, Fisher's exact test, and ANOVA. RESULTS: In the 5 min VF cohort, the rate of ROSC did not differ between the three groups (90 s: 25%; 180 s: 38%; 300 s: 38%, p>.05). Survival rates did not differ (90 s: 25%; 180 s: 25%; 300 s: 25%, p>0.05). In the 8 min VF cohort, no animals experienced ROSC or survival. CPP were calculated by 30s epoch and did not differ between the three groups (p>0.05). CPPs decline after 180 s of CPR. CONCLUSIONS: ROSC and survival were equivalent regardless of VF duration and CPR duration. When CPR begins late, CPPs are low, stressing the importance of early CPR. We do not recommend 300 s of CPR unless a defibrillator is unavailable.
Authors:
Jon C Rittenberger; Brian Suffoletto; David Salcido; Eric Logue; James J Menegazzi
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2008-07-11
Journal Detail:
Title:  Resuscitation     Volume:  79     ISSN:  0300-9572     ISO Abbreviation:  Resuscitation     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-22     Completed Date:  2009-01-27     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  155-60     Citation Subset:  IM    
Affiliation:
University of Pittsburgh, Department of Emergency Medicine, Pittsburgh, PA 15213, USA. rittenbergerjc@upmc.edu
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Cardiopulmonary Resuscitation / methods*
Disease Models, Animal
Electric Countershock / methods*
Hemodynamics / physiology
Random Allocation
Regional Blood Flow
Survival Rate
Swine
Time Factors
Ventricular Fibrillation / physiopathology,  therapy*
Grant Support
ID/Acronym/Agency:
1 KL2 RR024154-02/RR/NCRR NIH HHS; 5R01HL080483-2/HL/NHLBI NIH HHS; 5U01 HL077871-02/HL/NHLBI NIH HHS; L30 HL090007-01/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Resuscitation. 2009 Mar;80(3):382; author reply 382-3   [PMID:  19111376 ]

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