Document Detail


Sodium nitroprusside-enhanced cardiopulmonary resuscitation improves resuscitation rates after prolonged untreated cardiac arrest in two porcine models.
MedLine Citation:
PMID:  21725236     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Sodium nitroprusside-enhanced cardiopulmonary resuscitation consists of active compression-decompression, an impedance threshold device, abdominal binding, and large intravenous doses of sodium nitroprusside. We hypothesize that sodium nitroprusside-enhanced cardiopulmonary resuscitation will significantly increase carotid blood flow and return of spontaneous circulation compared to standard cardiopulmonary resuscitation after prolonged ventricular fibrillation and pulseless electrical activity cardiac arrest.
DESIGN: Prospective randomized animal study.
SETTING: Hennepin County Medical Center Animal Laboratory.
SUBJECTS: Forty Yorkshire female farm-bred pigs weighing 32 ± 2 kg.
INTERVENTIONS: In protocol A, 24 isoflurane-anesthetized pigs underwent 15 mins of untreated ventricular fibrillation and were subsequently randomized to receive standard cardiopulmonary resuscitation (n = 6), active compression-decompression cardiopulmonary resuscitation + impedance threshold device (n = 6), or sodium nitroprusside-enhanced cardiopulmonary resuscitation (n = 12) for up to 15 mins. First defibrillation was attempted at minute 6 of cardiopulmonary resuscitation. In protocol B, a separate group of 16 pigs underwent 10 mins of untreated ventricular fibrillation followed by 3 mins of chest compression only cardiopulmonary resuscitation followed by countershock-induced pulseless electrical activity, after which animals were randomized to standard cardiopulmonary resuscitation (n = 8) or sodium nitroprusside-enhanced cardiopulmonary resuscitation (n = 8).
MEASUREMENTS AND MAIN RESULTS: The primary end point was carotid blood flow during cardiopulmonary resuscitation and return of spontaneous circulation. Secondary end points included end-tidal CO2 as well as coronary and cerebral perfusion pressure. After prolonged untreated ventricular fibrillation, sodium nitroprusside-enhanced cardiopulmonary resuscitation demonstrated superior rates of return of spontaneous circulation when compared to standard cardiopulmonary resuscitation and active compression-decompression cardiopulmonary resuscitation + impedance threshold device (12 of 12, 0 of 6, and 0 of 6 respectively, p < .01). In animals with pulseless electrical activity, sodium nitroprusside-enhanced cardiopulmonary resuscitation increased return of spontaneous circulation rates when compared to standard cardiopulmonary resuscitation. In both groups, carotid blood flow, coronary perfusion pressure, cerebral perfusion pressure, and end-tidal CO2 were increased with sodium nitroprusside-enhanced cardiopulmonary resuscitation.
CONCLUSIONS: In pigs, sodium nitroprusside-enhanced cardiopulmonary resuscitation significantly increased return of spontaneous circulation rates, as well as carotid blood flow and end-tidal CO2, when compared to standard cardiopulmonary resuscitation or active compression-decompression cardiopulmonary resuscitation + impedance threshold device.
Authors:
Jason C Schultz; Nicolas Segal; Emily Caldwell; James Kolbeck; Scott McKnite; Nick Lebedoff; Menekhem Zviman; Tom P Aufderheide; Demetris Yannopoulos
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  39     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-18     Completed Date:  2012-01-13     Revised Date:  2014-09-19    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2705-10     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Pressure / drug effects
Cardiopulmonary Resuscitation / methods*
Coronary Circulation / drug effects
Disease Models, Animal
Echocardiography
Female
Heart Arrest / drug therapy*,  therapy
Nitroprusside / therapeutic use*
Stroke Volume / drug effects
Swine
Vasodilator Agents / therapeutic use*
Grant Support
ID/Acronym/Agency:
R01 HL108926/HL/NHLBI NIH HHS; R01 HL108926-01/HL/NHLBI NIH HHS; R01 HL108926-01/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 169D1260KM/Nitroprusside
Comments/Corrections
Comment In:
Crit Care Med. 2011 Dec;39(12):2775-6   [PMID:  22094513 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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