title: Coagulopathy during cardiac arrest and resuscitation in a swine model of electrically induced ventricular fibrillation.
abstract: OBJECTIVE
  Coagulopathy is often present after resuscitation from cardiac arrest but plays an undefined role in the post cardiac arrest syndrome. The aim of this study was to characterize coagulation changes during cardiac arrest and post-resuscitation care in order to direct further focused study.
  
  
  METHODS
  Ventricular fibrillation (VF) was induced electrically in immature male swine, followed by normothermic American Heart Association Advanced Cardiac Life Support and a uniform post-resuscitation goal-directed resuscitation protocol. PT, aPTT, fibrinogen, Thrombelastography (TEG), platelet contractile force (PCF), clot elastic modulus (CEM), and collagen-induced platelet aggregation were compared at baseline, at 8 min of VF, during the 3rd round of chest compressions (CPR), and at 15, 90, 180, and 360 min after return of circulation using repeated measures ANOVA.
  
  
  RESULTS
  8/18 (44%) animals were resuscitated after 10.9 ± 0.9 min of VF and 7.6 ± 3.4 min of CPR. TEG revealed a significant impairment in clot strength (MA) and clot formation kinetics (K, alpha angle) arising during CPR, followed by a brief prolongation of clot onset times (R) after return of circulation. Both PCF and CEM fell significantly during CPR (PCF by 50%, CEM by 47% of baseline) and platelet aggregation was significantly decreased during CPR. Coagulation changes were partially recovered by 3h of post-resuscitation care.
  
  
  CONCLUSIONS
  Whole blood coagulation was rapidly impaired during CPR after electrically induced VF in this swine model by impaired platelet aggregation/contractile function and clotting kinetics. Further platelet-specific study is indicated.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA. whiten4@u.washington.edu
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: White
authors.forename: Benjamin Sieu-Hon
authors.initials: BS
authors.lastname: Leong
authors.forename: Jessica
authors.initials: J
authors.lastname: Brueckner
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Martin
authors.forename: Donald F
authors.initials: DF
authors.lastname: Brophy
authors.forename: Mary A
authors.initials: MA
authors.lastname: Peberdy
authors.forename: Joseph
authors.initials: J
authors.lastname: Ornato
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Ward
mesh_terms: D000818:Animals; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods; D004195:Disease Models, Animal; D005340:Fibrinogen / Q000378:metabolism; D006323:Heart Arrest / Q000097:blood / Q000150:complications* / Q000628:therapy; D006339:Heart Rate; D008297:Male; D010974:Platelet Aggregation; D012307:Risk Factors; D013552:Swine; D013916:Thrombelastography; D014693:Ventricular Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000628:therapy
chemical_list: D005340:Fibrinogen