Augmentation of tissue perfusion by a novel compression device increases neurologically intact survival in a porcine model of prolonged cardiac arrest.
OBJECTIVE
This study was performed to determine the potential efficacy of an automated device with a load-distributing band (AutoPulse, Revivant Corporation), in improving neurologically intact survival after cardiac arrest.


METHODS
Randomized, controlled trial.


METHODS
University animal laboratory.


METHODS
Forty-four swine (18-23 kg).


METHODS
Eight minutes after induction of untreated ventricular fibrillation, pigs were randomized to AutoPulse-CPR (A-CPR, n = 22), conventional cardiopulmonary resuscitation (CPR) with 20% anterior-posterior chest displacement (C-CPR20, n = 10) or 30% chest displacement (C-CPR30, n = 12), followed by resuscitation protocol with ventilation, defibrillation and intravenous epinephrine (adrenaline).


RESULTS
Aortic and right atrium blood pressure was measured with micromanometers. Regional blood flows were measured with microspheres. Coronary perfusion pressure during A-CPR was significantly higher as compared to C-CPR without epinephrine (A-CPR versus C-CPR20 versus C-CPR30; 16 +/- 1 mmHg versus 7 +/- 2 mmHg versus 11 +/- 2 mmHg, p < 0.05). A-CPR improved both myocardial flow without epinephrine (A-CPR versus C-CPR20 versus C-CPR30; 23% versus 0% versus 4%; percent of baseline, p < 0.05) and cerebral blood flow (40% versus 4% versus 19%, percent of baseline, p < 0.05). Sixteen of 22 animals receiving A-CPR regained spontaneous circulation and survived; 14/22 had normal cerebral performance (CPC 1). Four of 12 animals receiving C-CPR30 regained spontaneous circulation and survived, but only one animal had normal neurological function (14/22 versus 1/12, p < 0.0001). No animal receiving C-CPR20 achieved spontaneous circulation. At necropsy, 67% of C-CPR30 had rib fracture and 33% showed lung injury, while A-CPR and C-CPR20 resulted in no detectable injuries.


CONCLUSIONS
Improved hemodynamics with AutoPulse performed CPR results in improved neurologically intact survival without subsequent thoracic or pulmonary injuries in this porcine model of prolonged cardiac arrest.
Ikeno
Fumiaki
F
Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA.
Kaneda
Hideaki
H
Hongo
Yoichiro
Y
Sakanoue
Yuji
Y
Nolasco
Christine
C
Emami
Sascha
S
Lyons
Jennifer
J
Rezaee
Mehrdad
M
D000818:Animals; D002245:Carbon Dioxide / Q000032:analysis; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002560:Cerebrovascular Circulation; D003326:Coronary Circulation; D004837:Epinephrine / Q000627:therapeutic use; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D015996:Survival Rate; D013552:Swine; D016277:Ventricular Function, Left
D002245:Carbon Dioxide; D004837:Epinephrine