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 journalArticlepeer-review

39 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

Bibliographical note

Funding Information:
Supported, in part, by an Institutional Division of Cardiology grant at the University of Minnesota to Dr. Yannopoulos.

Funding Information:
Dr. Lurie is the founder of Advance Circulatory Systems Incorporated (ACSI), and coinventor of the inspiratory impedance threshold device and ACD CPR technique used in this study. Dr. Yannopoulos received funding from the Division of Cardiology at the University of Minnesota. Dr. Lurie received a patent and holds stock ownership with ACD and ITD CPR (ACSI). The remaining authors have not disclosed any potential conflicts of interest.

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

Keywords

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

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