Effects of hypertonic saline on myocardial blood flow in a porcine model of prolonged cardiac arrest.
OBJECTIVE
To evaluate the effects of hypertonic saline (HS) on myocardial reperfusion pressure (MPP) and blood flow (MBF), and cardiac index (CI) during and after cardiopulmonary resuscitation (CPR).


METHODS
In 21 domestic swine (16-23 kg) open chest cardiac massage was initiated after 10 min of ventricular fibrillation. With the onset of CPR animals randomly received HS (7.2%; 2 ml/kg per 10 min or 4 ml/kg per 20 min) or normal saline ((NS); 2 ml/kg per 10 min). Haemodynamic variables were monitored continuously, and coloured microspheres were used to measure MBF and CI before cardiac arrest (CA), during CPR and 5, 30 and 120 min after the return of spontaneous circulation.


RESULTS
During CPR HS significantly increased MPP, MBF, and CI in comparison to NS (P<0.05, resp., MANOVA). Doubling the volume of HS did not improve the haemodynamic effects seen after application of 2 ml/kg per 10 min. HS-infusion significantly increased the survival rate at 120 min, 6/7 and 5/7 animals receiving 2 ml/kg per 10 min or 4 ml/kg per 20 min versus 2/7 after NS-infusion (P<0.05, chi(2)-test).


CONCLUSIONS
HS applied during open chest cardiac massage enhanced MBF and CI, and significantly increased resuscitation success and survival rate. The positive effects of this promising new approach need to be confirmed in clinical studies.
Fischer
Matthias
M
Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Sigmund Freud Street 25, D-53105, Bonn, Germany. matthias.fischer@ukb.uni-bonn.de
Dahmen
Alfred
A
Standop
Jens
J
Hagendorff
Andreas
A
Hoeft
Andreas
A
Krep
Henning
H
D000818:Animals; D003326:Coronary Circulation / Q000187:drug effects* / Q000502:physiology; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage; D015425:Myocardial Reperfusion; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D013552:Swine; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000503:physiopathology
D012462:Saline Solution, Hypertonic