Sodium nitroprusside enhanced cardiopulmonary resuscitation improves survival with good neurological function in a porcine model of prolonged cardiac arrest

Demetris Yannopoulos, Timothy Matsuura, Jason Schultz, Kyle Rudser, Henry R. Halperin, Keith G. Lurie

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

Objective: To assess the effectiveness of sodium nitroprusside (SNP)-"enhanced" cardiopulmonary resuscitation (SNPeCPR) on 24-hr survival rates compared to standard CPR in animals after cardiac arrest. SNPeCPR consists of large intravenous SNP bolus doses during CPR enhanced by active compression-decompression CPR, an inspiratory impedance threshold device (ITD), and abdominal binding (AB). The combination of active compression-decompression CPR+ITD+AB without SNP will be called "enhanced" or eCPR. Design: Randomized, blinded, animal study. Setting: Preclinical animal laboratory. SUBJECTS:: Twenty-four female farm pigs (30 ± 1 kg). Interventions: Isoflurane anesthetized and intubated pigs were randomized after 8 mins of untreated ventricular fibrillation to receive either standard CPR (n = 8), SNPeCPR (n = 8), or eCPR (n = 8) for 25 mins followed by defibrillation. Measurements and Main Results: The primary end point was carotid blood flow during CPR and 24-hr survival with good neurologic function defined as an overall performance category score of ≤2 (1 = normal, 5 = brain dead or dead). Secondary end points included hemodynamics and end-tidal CO2. SNPeCPR significantly improved carotid blood flow and 24-hr survival rates with good neurologic function compared to standard CPR or eCPR (six of eight vs. zero of eight vs. one of eight, p < .05). The improved survival rates were associated with higher coronary perfusion pressure and ETco2 during CPR. Conclusion: In pigs, SNPeCPR significantly improved hemodynamics, resuscitation rates, and 24-hr survival rates with good neurologic function after cardiac arrest when compared with standard CPR or eCPR alone.

Original languageEnglish (US)
Pages (from-to)1269-1274
Number of pages6
JournalCritical care medicine
Volume39
Issue number6
DOIs
StatePublished - Jun 2011

Keywords

  • cardiopulmonary resuscitation
  • carotid blood flow
  • neurological function
  • resuscitation rates
  • vasodilators

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