title: Excellent coronary perfusion pressure during cardiopulmonary resuscitation is not good enough to ensure long-term survival with good neurologic outcome: a porcine case report.
abstract: OBJECTIVE
  To report a case of cerebral ischemia confirmed by magnetic resonance imaging after successful cardiopulmonary resuscitation (CPR) complicated by acute respiratory injury.
  
  
  METHODS
  After 4 min of cardiac arrest, followed by 3 min of basic life support CPR, a female pig weighing 38 kg received every 5 min vasopressin (0.4, 0.4 and 0.8 U/kg). After 22 min of cardiac arrest, including 18 min of CPR, one defibrillation attempt employing 100 J resulted in return of spontaneous circulation. Neurological evaluation was performed 24 and 96 h after successful CPR. Magnetic resonance imaging was carried out 4 days after CPR using a clinical 1.5 T scanner. The magnetic resonance imaging protocol consisted of fast spinecho T2-weighted, as well as spinecho T1-weighted imaging of the brain.
  
  
  RESULTS
  CPR with vasopressin resulted in excellent coronary perfusion pressure ranging between 35 and 60 mm Hg throughout CPR. Eight minutes after initiation of chest compressions, bleeding out of the tracheal tube occurred. This was later confirmed as originating from bilateral bloody pulmonary infiltrations, resulting in acute respiratory injury in the post-resuscitation phase. Ninety-six hours after successful CPR, magnetic resonance imaging revealed bilateral diffuse cerebral vasogenic edema.
  
  
  CONCLUSIONS
  Although excellent coronary perfusion pressure renders a return of spontaneous circulation more likely, complications such as acute respiratory injury in the post-resuscitation phase have to be managed carefully in order to ensure good neurological recovery from cardiac arrest.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, The Leopold-Franzens-University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. birgit.enna@uibk.ac.at
authors.forename: B
authors.initials: B
authors.lastname: Enna
authors.forename: V
authors.initials: V
authors.lastname: Wenzel
authors.forename: M
authors.initials: M
authors.lastname: Schocke
authors.forename: A C
authors.initials: AC
authors.lastname: Krismer
authors.forename: W G
authors.initials: WG
authors.lastname: Voelckel
authors.forename: G
authors.initials: G
authors.lastname: Klima
authors.forename: S
authors.initials: S
authors.lastname: Felber
authors.forename: K
authors.initials: K
authors.lastname: Pfaller
authors.forename: K H
authors.initials: KH
authors.lastname: Lindner
mesh_terms: D000208:Acute Disease; D000818:Animals; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000175:diagnosis / Q000503:physiopathology; D016887:Cardiopulmonary Resuscitation; D003326:Coronary Circulation; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology; D007421:Intestine, Small / Q000473:pathology; D008171:Lung Diseases / Q000209:etiology; D008279:Magnetic Resonance Imaging; D009206:Myocardium / Q000473:pathology; D009420:Nervous System / Q000503:physiopathology*; D012120:Respiration Disorders / Q000209:etiology; D016019:Survival Analysis; D013552:Swine; D013997:Time Factors; D017211:Treatment Failure