Bundled postconditioning therapies improve hemodynamics and neurologic recovery after 17 min of untreated cardiac arrest

Jason A. Bartos, Timothy R. Matsuura, Mohammad Sarraf, Scott T. Youngquist, Scott H. McKnite, Jennifer N. Rees, Daniel T. Sloper, Frank S. Bates, Nicolas Segal, Guillaume Debaty, Keith G. Lurie, Robert W. Neumar, Joseph M. Metzger, Matthias L. Riess, Demetris Yannopoulos

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Objective: Ischemic postconditioning (stutter CPR) and sevoflurane have been shown to mitigate the effects of reperfusion injury in cardiac tissue after 15. min of ventricular fibrillation (VF) cardiac arrest. Poloxamer 188 (P188) has also proven beneficial to neuronal and cardiac tissue during reperfusion injury in human and animal models. We hypothesized that the use of stutter CPR, sevoflurane, and P188 combined with standard advanced life support would improve post-resuscitation cardiac and neurologic function after prolonged VF arrest. Methods: Following 17. min of untreated VF, 20 pigs were randomized to Control treatment with active compression/decompression (ACD) CPR and impedance threshold device (ITD) (n= 8) or Bundle therapy with stutter ACD CPR + ITD + sevoflurane + P188 (n= 12). Epinephrine and post-resuscitation hypothermia were given in both groups per standard protocol. Animals that achieved return of spontaneous circulation (ROSC) were evaluated with echocardiography, biomarkers, and a blinded neurologic assessment with a cerebral performance category score. Results: Bundle therapy improved hemodynamics during resuscitation, reduced need for epinephrine and repeated defibrillation, reduced biomarkers of cardiac injury and end-organ dysfunction, and increased left ventricular ejection fraction compared to Controls. Bundle therapy also improved rates of ROSC (100% vs. 50%), freedom from major adverse events (50% vs. 0% at 48. h), and neurologic function (42% with mild or no neurologic deficit and 17% achieving normal function at 48. h). Conclusions: Bundle therapy with a combination of stutter ACD CPR, ITD, sevoflurane, and P188 improved cardiac and neurologic function after 17. min of untreated cardiac arrest in pigs. All studies were performed with approval from the Institutional Animal Care Committee of the Minneapolis Medical Research Foundation (protocol #12-11).

Original languageEnglish (US)
Pages (from-to)7-13
Number of pages7
StatePublished - Feb 1 2015

Bibliographical note

Funding Information:
Dr. Yannopoulos is funded by an Institutional, Division of Cardiology grant at the University of Minnesota and the following NIH grants for CPR and resuscitation research ( R01HL108926-01 and R01HL123227 ). Dr. Riess received research funding from institutional funds, Department of Veterans Affairs (CARA-026-10F to MLR) and the National Institutes of Health.

Publisher Copyright:
© 2014 Elsevier Ireland Ltd.


  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Poloxamer 188
  • Postconditioning
  • Sevoflurane
  • Ventricular fibrillation


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