No assisted ventilation cardiopulmonary resuscitation and 24-hour neurological outcomes in a porcine model of cardiac arrest. Crit Care Med 2010 Jan;38(1):254-60
Date
10/01/2009Pubmed ID
19789452DOI
10.1097/CCM.0b013e3181b42f6cScopus ID
2-s2.0-74049089643 (requires institutional sign-in at Scopus site) 50 CitationsAbstract
OBJECTIVES: To evaluate the effect of no assisted ventilation cardiopulmonary resuscitation on neurologically intact survival compared with ten positive pressure ventilations/minute cardiopulmonary resuscitation in a pig model of cardiac arrest.
DESIGN: Prospective randomized animal study.
SETTING: Animal laboratory.
SUBJECTS: Sixteen female intubated pigs (25.2 +/- 2.1 kg) anesthetized with propofol.
INTERVENTIONS: : fter 8 mins of untreated ventricular fibrillation, the intubated animals were randomized to 8 mins of continuous chest compressions (100/min) and either no assisted ventilation (n = 9) or 10 positive pressure ventilations/min (Smart Resuscitator Bag with 100% O2 flow at 10 L/min) (n = 7). The primary end point, neurologically intact 24-hr survival, was evaluated using a pig cerebral performance category score by a veterinarian blinded to the cardiopulmonary resuscitation method. MEASUREMENTS, AND MAIN RESULTS: During cardiopulmonary resuscitation, aortic and coronary perfusion pressure were similar between groups but cerebral perfusion pressure was significantly higher in the positive pressure ventilation group (33 +/- 15 vs. 14 +/- 14, p = .04). After 7.5 mins of cardiopulmonary resuscitation, arterial pO2 (mm Hg) and mixed venous O2 saturation (%) were significantly higher in the positive pressure ventilation compared with the no assisted ventilation group (117 +/- 29 and 41 +/- 21 vs. 40 +/- 24 and 10.8 +/- 7; p = .01 for both). Paco2 was significantly lower in the positive pressure ventilation group (48 +/- 10 vs. 77 +/- 26, p = .01). After 24 hrs, four of nine no assisted ventilation pigs were alive with a mean cerebral performance category score of 3 +/- 0 vs. five of seven alive and neurologically intact positive pressure ventilation pigs with a cerebral performance category score of 1 +/- 0.3 (p < .001 for cerebral performance category score).
CONCLUSIONS: No assisted ventilation cardiopulmonary resuscitation results in profound hypoxemia, respiratory acidosis, and significantly worse 24-hr neurologic outcomes compared with positive pressure ventilation cardiopulmonary resuscitation in pigs.
Author List
Yannopoulos D, Matsuura T, McKnite S, Goodman N, Idris A, Tang W, Aufderheide TP, Lurie KGAuthor
Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AnimalsBlood Gas Analysis
Cardiopulmonary Resuscitation
Chest Wall Oscillation
Chi-Square Distribution
Disease Models, Animal
Female
Heart Arrest
Hypoxia
Incidence
Nervous System Diseases
Neurologic Examination
Positive-Pressure Respiration
Probability
Pulmonary Circulation
Random Allocation
Reference Values
Risk Factors
Survival Analysis
Swine
Ventricular Fibrillation