title: A comparison of cardiopulmonary resuscitation with cardiopulmonary bypass after prolonged cardiac arrest in dogs. Reperfusion pressures and neurologic recovery.
abstract: Resuscitability and outcome after prolonged cardiac arrest were compared in dogs with standard external cardiopulmonary resuscitation (CPR) vs. closed-chest emergency cardiopulmonary bypass (CPB). Ventricular fibrillation (VF) was with no blood flow from VF 0 min to VF 10 min. Subsequent CPR basic life support (BLS) was from 10 min to VF 15 min. Then, group I (n = 13) received CPR advanced life support (ALS) from VF 15 min until restoration of spontaneous circulation to occur not later than VF 40 min. Group II (n = 14) received CPR-ALS from VF 15 min to VF 20 min without defibrillation, and then total CPB to defibrillation attempts started at VF 20 min, followed by assisted CPB to 2 h. Total ischemia time (no-flow time plus CPR time of MAP less than 50 mmHg) was unexpectedly shorter in group I (14.3 +/- 2.5 min) than in group II (18.6 +/- 2.3 min) (P less than 0.01). During CPR-BLS, coronary perfusion pressures were 25 +/- 9 mmHg in group I and 18 +/- 8 mmHg in group II (NS). Epinephrine during CPR-ALS, before countershock, raised coronary perfusion pressure to 40 +/- 10 mmHg in group I and 27 +/- 10 mmHg in group II (NS). In group II, coronary perfusion pressure increased during total CPB to 58 +/- 16 mmHg (P less than 0.01 vs. group I). Spontaneous normotension was restored in 11/13 dogs of group I and all 14 dogs of group II (NS). Ten dogs in each group followed protocol and survived to 96 h. Five of ten in group I and six of ten in group II were neurologically normal (NS). We conclude that: (1) Reperfusion with CPB yields higher coronary perfusion pressures than reperfusion with CPR-ALS; and (2) even after no blood flow for 10 min, optimized CPR can result in cardiovascular resuscitability and neurologic recovery, similar to those achieved by CPB.
authors.affiliation: International Resuscitation Research Center (IRRC), University of Pittsburgh, PA 15260.
authors.forename: M
authors.initials: M
authors.lastname: Angelos
authors.forename: P
authors.initials: P
authors.lastname: Safar
authors.forename: H
authors.initials: H
authors.lastname: Reich
mesh_terms: D000818:Animals; D002315:Cardiopulmonary Bypass; D002320:Cardiovascular Physiological Phenomena; D002490:Central Nervous System / Q000502:physiology*; D004285:Dogs; D004569:Electroencephalography; D006323:Heart Arrest / Q000628:therapy*; D008020:Life Support Care; D008297:Male; D015424:Reperfusion / Q000379:methods*; D012121:Respiration, Artificial; D012151:Resuscitation / Q000379:methods*; D014693:Ventricular Fibrillation / Q000628:therapy