title: Dynamic and volumetric variables of fluid responsiveness fail during immediate postresuscitation period.
abstract: OBJECTIVE
  Fluid therapy after resuscitation from cardiac arrest is challenging since both hypovolemia and fluid overload may cause circulatory failure. Therefore, prediction of fluid responsiveness is a major issue in optimizing hemodynamic therapy. The aim of the present study was to evaluate the performance of stroke volume variation, pulse pressure variation, variation of Doppler-derived velocity time integral, and global end-diastolic volume index to predict fluid responsiveness in the postcardiac arrest period.
  
  
  METHODS
  Prospective animal study.
  
  
  METHODS
  University-affiliated research laboratory.
  
  
  METHODS
  Twenty anesthetized and ventilated Goettinger minipigs.
  
  
  METHODS
  Animals were equipped with a central venous catheter, a thermistor-tipped arterial catheter, and a transesophageal echo probe. Electrically induced cardiac arrest of 8 mins was followed by cardiopulmonary resuscitation. Hemodynamic measurements were performed before and after a two-step fluid bolus at baseline and both 1 and 4 hrs after return of spontaneous circulation. Fluid responsiveness was defined by an increase in stroke volume of at least 15%. Performance of variables was analyzed using receiver operator characteristics analysis.
  
  
  RESULTS
  Variables reliably indicated fluid responsiveness at baseline. Fifteen animals were successfully resuscitated. Left ventricular ejection fraction was significantly reduced 1 hr after return of spontaneous circulation (52.6% ± 6.4%; p < .01) compared with baseline (69.9% ± 5.3%). One hour after return of spontaneous circulation, fluid responsiveness could not be predicted by any variable. In contrast, pulse pressure variation, variation of the velocity time integral, and global end-diastolic volume index, but not stroke volume variation, were able to predict fluid responsiveness 4 hrs after return of spontaneous circulation, since area under the curve was 0.85 (p < .01), 0.94 (p < .01), 0.77 (p = .02), and 0.68 (p = .12), respectively.
  
  
  CONCLUSIONS
  Prediction of fluid responsiveness failed 1 hr after successful cardiopulmonary resuscitation from cardiac arrest. Four hours after return of spontaneous circulation, however, the variables pulse pressure variation, variation of the velocity time integral, and global end-diastolic volume index, but not stroke volume variation, enabled prediction of fluid responsiveness and may, therefore, be considered for subsequent hemodynamic optimization after successful cardiopulmonary resuscitation.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany. gruenewald@anaesthesie.uni-kiel.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Gruenewald
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
authors.forename: Sebastian
authors.initials: S
authors.lastname: Koerner
authors.forename: Jochen
authors.initials: J
authors.lastname: Renner
authors.forename: Moritz
authors.initials: M
authors.lastname: Maracke
authors.forename: Juergen
authors.initials: J
authors.lastname: Schrezenmeir
authors.forename: Markus
authors.initials: M
authors.lastname: Steinfath
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
mesh_terms: D000222:Adaptation, Physiological; D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002496:Central Venous Pressure; D004195:Disease Models, Animal; D017548:Echocardiography, Transesophageal; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology*; D008297:Male; D012372:ROC Curve; D011897:Random Allocation; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D013552:Swine; D013556:Swine, Miniature; D013997:Time Factors