Document Detail


The critical importance of minimal delay between chest compressions and subsequent defibrillation: a haemodynamic explanation.
MedLine Citation:
PMID:  12969599     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Outcome after prehospital defibrillation remains dire. The aim of the present study was to elucidate the pathophysiology of cardiac arrest and to suggest ways to improve outcome. Ventricular fibrillation (VF) was induced in air-ventilated pigs, after which ventilation was withdrawn. After 6.5 min of VF, ventilation with 100% oxygen was initiated. In six pigs (group I), defibrillation was the only treatment carried out. In another six pigs (group II), mechanical chest compression-decompression CPR (mCPR) was carried out for 3.5 min followed by a 40-s hands-off period before defibrillation. If unsuccessful, mCPR was resumed for a further 30 s before a second or a third, 40-s delayed, shock was given. In a final six pigs (group III) mCPR was applied for 3.5 min after which up to three shocks (if needed) were given during on-going mCPR. Return of spontaneous circulation (ROSC) occurred in none of the pigs in group I (0%), in 1 of six pigs in group II (17%) and in five of six pigs in group III (83%). During the first 3 min of VF arterial blood was transported to the venous circulation, with the consequence that the left ventricle emptied and the right ventricle became greatly distended. It took 2 min of mCPR to establish an adequate coronary perfusion pressure, which was lost when the mCPR was interrupted. During 30 s of mCPR coronary perfusion pressure was negative, but a carotid flow of about 25% of basal value was obtained. In this pig model, VF caused venous congestion, an empty left heart, and a greatly distended right heart within 3 min. Adequate heart massage before and during defibrillation greatly improved the likelihood of return of spontaneous circulation (ROSC).
Authors:
Stig Steen; Qiuming Liao; Leif Pierre; Audrius Paskevicius; Trygve Sjöberg
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Resuscitation     Volume:  58     ISSN:  0300-9572     ISO Abbreviation:  Resuscitation     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-09-12     Completed Date:  2004-04-01     Revised Date:  2009-08-25    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  249-58     Citation Subset:  IM    
Affiliation:
Heart-Lung Division, University Hospital of Lund, SE-221 85 Lund, Sweden. stig.steen@thorax.lu.se
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MeSH Terms
Descriptor/Qualifier:
Animals
Cardiopulmonary Resuscitation / methods*
Coronary Circulation / physiology*
Disease Models, Animal
Electric Countershock / methods*
Heart Arrest / complications,  therapy*
Hemodynamics
Swine
Ventricular Fibrillation / etiology,  therapy*
Comments/Corrections
Comment In:
Resuscitation. 2003 Sep;58(3):237-47   [PMID:  12969598 ]

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


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