Document Detail


No assisted ventilation cardiopulmonary resuscitation and 24-hour neurological outcomes in a porcine model of cardiac arrest.
MedLine Citation:
PMID:  19789452     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To evaluate the effect of no assisted ventilation cardiopulmonary resuscitation on neurologically intact survival compared with ten positive pressure ventilations/minute cardiopulmonary resuscitation in a pig model of cardiac arrest. DESIGN: Prospective randomized animal study. SETTING: Animal laboratory. SUBJECTS: Sixteen female intubated pigs (25.2 +/- 2.1 kg) anesthetized with propofol. INTERVENTIONS:: fter 8 mins of untreated ventricular fibrillation, the intubated animals were randomized to 8 mins of continuous chest compressions (100/min) and either no assisted ventilation (n = 9) or 10 positive pressure ventilations/min (Smart Resuscitator Bag with 100% O2 flow at 10 L/min) (n = 7). The primary end point, neurologically intact 24-hr survival, was evaluated using a pig cerebral performance category score by a veterinarian blinded to the cardiopulmonary resuscitation method. MEASUREMENTS, AND MAIN RESULTS: During cardiopulmonary resuscitation, aortic and coronary perfusion pressure were similar between groups but cerebral perfusion pressure was significantly higher in the positive pressure ventilation group (33 +/- 15 vs. 14 +/- 14, p = .04). After 7.5 mins of cardiopulmonary resuscitation, arterial pO2 (mm Hg) and mixed venous O2 saturation (%) were significantly higher in the positive pressure ventilation compared with the no assisted ventilation group (117 +/- 29 and 41 +/- 21 vs. 40 +/- 24 and 10.8 +/- 7; p = .01 for both). Paco2 was significantly lower in the positive pressure ventilation group (48 +/- 10 vs. 77 +/- 26, p = .01). After 24 hrs, four of nine no assisted ventilation pigs were alive with a mean cerebral performance category score of 3 +/- 0 vs. five of seven alive and neurologically intact positive pressure ventilation pigs with a cerebral performance category score of 1 +/- 0.3 (p < .001 for cerebral performance category score). CONCLUSIONS: No assisted ventilation cardiopulmonary resuscitation results in profound hypoxemia, respiratory acidosis, and significantly worse 24-hr neurologic outcomes compared with positive pressure ventilation cardiopulmonary resuscitation in pigs.
Authors:
Demetris Yannopoulos; Timothy Matsuura; Scott McKnite; Noah Goodman; Ahamed Idris; Wanchun Tang; Tom P Aufderheide; Keith G Lurie
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  38     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-22     Completed Date:  2010-01-15     Revised Date:  2010-07-27    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  254-60     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, University of Minnesota, Minneapolis, MN, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Anoxia / diagnosis,  epidemiology
Blood Gas Analysis
Cardiopulmonary Resuscitation / methods*,  mortality
Chest Wall Oscillation / methods*,  mortality
Chi-Square Distribution
Disease Models, Animal
Female
Heart Arrest / etiology,  mortality,  therapy*
Incidence
Nervous System Diseases / diagnosis*,  epidemiology
Neurologic Examination
Positive-Pressure Respiration / methods*,  mortality
Probability
Pulmonary Circulation
Random Allocation
Reference Values
Risk Factors
Survival Analysis
Swine
Ventricular Fibrillation / complications,  therapy
Comments/Corrections
Comment In:
Crit Care Med. 2010 Jun;38(6):1502-3; author reply 1503-4   [PMID:  20502153 ]
Crit Care Med. 2010 Aug;38(8):1760-1   [PMID:  20647817 ]

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