Hypertonic saline improves myocardial blood flow during CPR, but is not enhanced further by the addition of hydroxy ethyl starch.
OBJECTIVE
To evaluate the effects of hypertonic saline (HS) and/or hydroxy ethyl starch (HES) on myocardial perfusion pressure (MPP) and blood flow (MBF), and cardiac index (CI) during and after cardiopulmonary resuscitation (CPR).


METHODS
In 32 domestic swine (13-23.5 kg) open chest CPR was initiated after 8 min of ventricular fibrillation. With the onset of CPR animals randomly received 2 ml/kg per 10 min of either HS (7.2% NaCl) or hypertonic HES saline (HHS) (6% HES 200000/0.5 in 7.2% NaCl) or HES (6% HES 200000/0.5 in 0.9% NaCl) or normal saline (NS) (0.9% NaCl). Haemodynamic variables were monitored continuously, and coloured microspheres were used to measure MBF and CI before cardiac arrest, during CPR, and 20, 90 and 240 min after restoration of spontaneous circulation.


RESULTS
During CPR HS and HHS significantly increased MBF in comparison to HES and NS (P<0.05, respectively, MANOVA). MPP and CI were not different between the groups. HS and HHS significantly increased resuscitation success and the 240 min survival rate. 14/15 animals receiving HS or HHS and 8/17 after HES-or NS -infusion survived the observation period (P<0.05, chi(2)-test). No negative side effects of HS with or without the addition of HES were observed.


CONCLUSIONS
Hypertonic solutions (HS and HHS) applied during internal cardiac massage enhanced MBF and significantly increased resuscitation success and survival rate. Addition of HES to HS did not further improve the positive haemodynamic effects of HS alone.
Breil
Martin
M
Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud Street 25, D-53105 Bonn, Germany. martin.breil@ukb.uni-bonn.de
Krep
Henning
H
Sinn
Daniel
D
Hagendorff
Andreas
A
Dahmen
Alfred
A
Eichelkraut
Wolfgang
W
Hoeft
Andreas
A
Fischer
Matthias
M
D000818:Animals; D001794:Blood Pressure; D002302:Cardiac Output; D016887:Cardiopulmonary Resuscitation; D003326:Coronary Circulation; D005440:Fluid Therapy; D006323:Heart Arrest / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D006400:Hematocrit; D006439:Hemodynamics; D006863:Hydrogen-Ion Concentration; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D019344:Lactic Acid / Q000097:blood; D009994:Osmolar Concentration; D010100:Oxygen / Q000097:blood; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011659:Pulmonary Gas Exchange; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012964:Sodium / Q000097:blood; D012965:Sodium Chloride / Q000008:administration & dosage; D013552:Swine
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D019344:Lactic Acid; D012965:Sodium Chloride; D012964:Sodium; D010100:Oxygen