Coronary blood flow produced by muscle contractions induced by intracardiac electrical CPR during ventricular fibrillation.
It has been reported that transthoracic electrical cardiopulmonary resuscitation (ECPR) generates coronary perfusion pressures (CPP) similar to manual chest compressions (MCC). We hypothesized that intracardiac ECPR produces similar CPP.


METHODS
ECPR pulse train protocols were applied for 20 seconds in a porcine model following 10 seconds of ventricular fibrillation (VF), using a defibrillator housing electrode and a right ventricular coil (IC-ECPR). Each protocol consisted of 200-ms electrical pulse trains applied at a rate of 100 pulse trains/min. The protocols were grouped in skeletal-based versus cardiac-based stimulation measurements. CPP was recorded and compared to historical MCC values generated by a similar experimental design. CPP > 15 mm Hg at 30 seconds of VF following the application of an IC-ECPR protocol was defined as successful.


RESULTS
Mean CPP for all intracardiac ECPR pulse train protocols at 30 seconds of VF was 14.8 +/- 3.8 mm Hg (n = 39). Mean CPP in seven successful skeletal-based IC-ECPR protocols was 19.4 +/- 3.2 mm Hg, and mean CPP in 10 successful cardiac-based IC-ECPR protocols was 17.4 +/- 2.1 mm Hg. Reported CPP for 15 MCC experiments at 30 seconds of VF was 22.9 +/- 9.4 mm Hg (P = 0.35 compared to skeletal-based IC-ECPR, P = 0.08 compared to cardiac-based IC-ECPR).


CONCLUSIONS
Intracardiac applied electrical CPR produced observable skeletal muscle contractions, measurable pressure pulses, and coronary perfusion pressures similar to MCC during a brief episode of untreated VF.
Wang
Hao
H
Weil Institute of Critical Care Medicine, Rancho Mirage, California, USA.
Tang
Wanchun
W
Tsai
Min-Shan
MS
Sun
Shijie
S
Li
Yongqin
Y
Gilman
Byron
B
Kroll
Mark W
MW
Guan
Jun
J
Brewer
James E
JE
Weil
Max H
MH
D000818:Animals; D001783:Blood Flow Velocity; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003326:Coronary Circulation; D004599:Electric Stimulation Therapy / Q000379:methods*; D008297:Male; D009119:Muscle Contraction; D013552:Swine; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000503:physiopathology* / Q000517:prevention & control*