TY - JOUR
T1 - Early coronary revascularization improves 24h survival and neurological function after ischemic cardiac arrest. A randomized animal study
AU - Sideris, Georgios
AU - Magkoutis, Nikolaos
AU - Sharma, Alok
AU - Rees, Jennifer
AU - McKnite, Scott
AU - Caldwell, Emily
AU - Sarraf, Mohammad
AU - Henry, Patrick
AU - Lurie, Keith
AU - Garcia, Santiago
AU - Yannopoulos, Demetris
PY - 2014/2
Y1 - 2014/2
N2 - Background: Survival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. We hypothesize that early coronary reperfusion will improve 24. h-survival and neurological outcomes. Methods: Total occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5. min, VF was induced and left untreated for 8. min. If return of spontaneous circulation (ROSC) was achieved within 15. min (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45. min (group A) or 4. h (group B) of LAD occlusion. Animals without ROSC after 15. min of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45. min of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10. min of CPR had been performed. Primary endpoints for groups A and B were 24-h survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion. Results: Early compared to late reperfusion improved survival (10/11 versus 4/10, p=0.02), mean CPC (1.4. ±. 0.7 versus 2.5. ±. 0.6, p=0.017), LVEF (43. ±. 13 versus 32. ±. 9%, p=0.01), troponin I (37. ±. 28 versus 99. ±. 12, p=0.005) and CK-MB (11. ±. 4 versus 20.1. ±. 5, p=0.031) at 24-h after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C. Conclusions: Early reperfusion after ischemic cardiac arrest improved 24. h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.
AB - Background: Survival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. We hypothesize that early coronary reperfusion will improve 24. h-survival and neurological outcomes. Methods: Total occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5. min, VF was induced and left untreated for 8. min. If return of spontaneous circulation (ROSC) was achieved within 15. min (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45. min (group A) or 4. h (group B) of LAD occlusion. Animals without ROSC after 15. min of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45. min of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10. min of CPR had been performed. Primary endpoints for groups A and B were 24-h survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion. Results: Early compared to late reperfusion improved survival (10/11 versus 4/10, p=0.02), mean CPC (1.4. ±. 0.7 versus 2.5. ±. 0.6, p=0.017), LVEF (43. ±. 13 versus 32. ±. 9%, p=0.01), troponin I (37. ±. 28 versus 99. ±. 12, p=0.005) and CK-MB (11. ±. 4 versus 20.1. ±. 5, p=0.031) at 24-h after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C. Conclusions: Early reperfusion after ischemic cardiac arrest improved 24. h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.
KW - 24h Survival rate
KW - Cerebral performance category (CPC) score
KW - Early coronary revascularization
KW - Return of spontaneous circulation (ROSC).
UR - http://www.scopus.com/inward/record.url?scp=84892840020&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84892840020&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2013.10.023
DO - 10.1016/j.resuscitation.2013.10.023
M3 - Article
C2 - 24200891
AN - SCOPUS:84892840020
SN - 0300-9572
VL - 85
SP - 292
EP - 298
JO - Resuscitation
JF - Resuscitation
IS - 2
ER -