Ischemic post-conditioning and vasodilator therapy during standard cardiopulmonary resuscitation to reduce cardiac and brain injury after prolonged untreated ventricular fibrillation

Demetris Yannopoulos, Nicolas Segal, Timothy Matsuura, Mohammad Sarraf, Marit Thorsgard, Emily Caldwell, Jennifer Rees, Scott McKnite, Karen SantaCruz, Keith G. Lurie

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Aim of the study: We investigated the effects of ischemic postconditioning (IPC) with and without cardioprotective vasodilatory therapy (CVT) at the initiation of cardiopulmonary resuscitation (CPR) on cardio-cerebral function and 48-h survival. Methods: Prospective randomized animal study. Following 15. min of ventricular fibrillation, 42 Yorkshire farm pigs weighing an average of 34. ±. 2. kg were randomized to receive standard CPR (SCPR, n= 12), SCPR. +. IPC (n= 10), SCPR. +. IPC. +. CVT (n= 10), or SCPR. +. CVT (n= 10). IPC was delivered during the first 3. min of CPR with 4 cycles of 20. s of chest compressions followed by 20-s pauses. CVT consisted of intravenous sodium nitroprusside (2. mg) and adenosine (24. mg) during the first minute of CPR. Epinephrine was given in all groups per standard protocol. A transthoracic echocardiogram was obtained on all survivors 1 and 4. h post-ROSC. The brains were extracted after euthanasia at least 24. h later to assess ischemic injury in 7 regions. Ischemic injury was graded on a 0-4 scale with (0. = no injury to 4 ≥50% neural injury). The sum of the regional scores was reported as cerebral histological score (CHS). 48. h survival was reported. Results: Post-resuscitation left ventricular ejection (LVEF) fraction improved in SCPR. +. CVT, SCPR. +. IPC. +. CVT and SCPR. +. IPC groups compared to SCPR (59%. ±. 9%, 52%. ±. 14%, 52%. ±. 14% vs. 35%. ±. 11%, respectively, p<. 0.05). Only SCPR. +. IPC and SCPR. +. IPC. +. CVT, but not SCPR. +. CVT, had lower mean CHS compared to SCPR (5.8. ±. 2.6, 2.8. ±. 1.8 vs. 10. ±. 2.1, respectively, p<. 0.01). The 48-h survival among SCPR. +. IPC, SCPR. +. CVT, SCPR. +. IPC. +. CVT and SCPR was 6/10, 3/10, 5/10 and 1/12, respectively (Cox regression p<. 0.01). Conclusions: IPC and CVT during standard CPR improved post-resuscitation LVEF but only IPC was independently neuroprotective and improved 48-h survival after 15. min of untreated cardiac arrest in pigs.

Original languageEnglish (US)
Pages (from-to)1143-1149
Number of pages7
JournalResuscitation
Volume84
Issue number8
DOIs
StatePublished - Aug 1 2013

Keywords

  • Cardiopulmonary resuscitation
  • Left ventricular function
  • Neurological function
  • Post-conditioning
  • Survival

Fingerprint Dive into the research topics of 'Ischemic post-conditioning and vasodilator therapy during standard cardiopulmonary resuscitation to reduce cardiac and brain injury after prolonged untreated ventricular fibrillation'. Together they form a unique fingerprint.

Cite this