Improving standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve in a porcine model of cardiac arrest

Keith G Lurie, Wolfgang G. Voelckel, Todd Zielinski, Scott McKnite, Paul Lindstrom, Colleen Peterson, Volker Wenzel, Karl H. Lindner, Nemer Samniah, David G Benditt

Research output: Contribution to journalArticlepeer-review

100 Scopus citations

Abstract

To improve the efficiency of standard cardiopulmonary resuscitation (CPR), we evaluated the potential value ofimpeding respiratory gas exchange selectively during the decompression phase of standard CPR in a porcine modelof ventricular fibrillation. After 6 min of untreated cardiac arrest, anesthetized farm pigs weighing 30 kg were randomized to be treated with either standard CPR with asham valve (n = 11) or standard CPR plus a functional inspiratory impedance threshold valve (ITV™) (n = 11).Coronary perfusion pressure (CPP) (diastolic aortic mius right atrial pressure) was the primary endpoint. Vital organ blood flow was assessed with radiolabeled microspheres after 6 min of CPR, and defibrillation was attempted 11 min after starting CPR. After 2 min of CPR, mean ± SEM CPP was 14 ± 2 mm Hg with the sham valve versus 20 ± 2 mm Hg in the ITV group (P < 0.006). Significantly higher CPPs were maintained throughout the study when the ITV was used. After 6 min of CPR, mean ±SEM left ventricular and global cerebral blood flows were 0.10 ± 0.03 and 0.19 ± 0.03 mL · min-1 · g-1 in the Control group versus 0.19 ± 0.03 and 0.26 ± 0.03 mL · min-1 · g-1in the ITV group, respectively (P < 0.05). Fifteen minutes after successful defibrillation, 2 of 11 animals were alive inthe Control group versus 6 of 11 in the ITV group (not significant). In conclusion, use of an inspiratory impedance valve during standard CPR resulted in a marked increase in CPP and vital organ blood flow after 6 min of cardiac arrest.

Original languageEnglish (US)
Pages (from-to)649-655
Number of pages7
JournalAnesthesia and analgesia
Volume93
Issue number3
DOIs
StatePublished - 2001

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