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 2013

Bibliographical note

Funding Information:
Demetris Yannopoulos MD, is the Medical Director of the Minnesota Resuscitation Consortium, a state wide initiative to improve survival in the state of MN from cardiac arrest. This initiative is sponsored by the Medtronic Foundation and is part of the Heart Rescue Program. There are no conflicts related to this investigation. Dr. Aufderheide has grants from NIHBI for the Resuscitation Outcomes Consortium, the ResQTrial, and the Immediate Trial; a grant from NINDS for the Neurological Emergency Treatment Trials (NETT) Network; he completed a paid consultancy on an acute myocardial infarction study with Medtronic in November, 2011; he volunteers on the Board of Directors for Take Heart America, President, Citizen CPR Foundation and is a volunteer for the National American Heart Association on the Basic Life Support Subcommittee and Research Working Group. He has no conflicts related to this investigation.The rest of the authors have no conflicts related to the study.

Funding Information:
The study was funded by an Institutional, Division of Cardiology Grant at the University of Minnesota and an R01 HL108926-01 NIH grant to Dr. Yannopoulos.

Keywords

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

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