title: Sodium nitroprusside enhanced cardiopulmonary resuscitation improves survival with good neurological function in a porcine model of prolonged cardiac arrest.
abstract: OBJECTIVE
  To assess the effectiveness of sodium nitroprusside (SNP)-"enhanced" cardiopulmonary resuscitation (SNPeCPR) on 24-hr survival rates compared to standard CPR in animals after cardiac arrest. SNPeCPR consists of large intravenous SNP bolus doses during CPR enhanced by active compression-decompression CPR, an inspiratory impedance threshold device (ITD), and abdominal binding (AB). The combination of active compression-decompression CPR+ITD+AB without SNP will be called "enhanced" or eCPR.
  
  
  METHODS
  Randomized, blinded, animal study.
  
  
  METHODS
  Preclinical animal laboratory.
  
  
  METHODS
  Twenty-four female farm pigs (30 ± 1 kg).
  
  
  METHODS
  Isoflurane anesthetized and intubated pigs were randomized after 8 mins of untreated ventricular fibrillation to receive either standard CPR (n = 8), SNPeCPR (n = 8), or eCPR (n = 8) for 25 mins followed by defibrillation.
  
  
  RESULTS
  The primary end point was carotid blood flow during CPR and 24-hr survival with good neurologic function defined as an overall performance category score of ≤2 (1 = normal, 5 = brain dead or dead). Secondary end points included hemodynamics and end-tidal CO2. SNPeCPR significantly improved carotid blood flow and 24-hr survival rates with good neurologic function compared to standard CPR or eCPR (six of eight vs. zero of eight vs. one of eight, p < .05). The improved survival rates were associated with higher coronary perfusion pressure and ETco2 during CPR.
  
  
  CONCLUSIONS
  In pigs, SNPeCPR significantly improved hemodynamics, resuscitation rates, and 24-hr survival rates with good neurologic function after cardiac arrest when compared with standard CPR or eCPR alone.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis-St. Paul, MN, USA. yanno001@umn.edu
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
authors.forename: Timothy
authors.initials: T
authors.lastname: Matsuura
authors.forename: Jason
authors.initials: J
authors.lastname: Schultz
authors.forename: Kyle
authors.initials: K
authors.lastname: Rudser
authors.forename: Henry R
authors.initials: HR
authors.lastname: Halperin
authors.forename: Keith G
authors.initials: KG
authors.lastname: Lurie
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002339:Carotid Arteries / Q000502:physiology; D004195:Disease Models, Animal; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D009599:Nitroprusside / Q000627:therapeutic use*; D012039:Regional Blood Flow; D013552:Swine; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D009599:Nitroprusside