Sodium nitroprusside enhanced cardiopulmonary resuscitation prevents post-resuscitation left ventricular dysfunction and improves 24-hour survival and neurological function in a porcine model of prolonged untreated ventricular fibrillation.
OBJECTIVE
Sodium nitroprusside-enhanced CPR, or SNPeCPR, consists of active compression-decompression CPR with an impedance threshold device, abdominal compression, and intravenous sodium nitroprusside (SNP). We hypothesize that SNPeCPR will improve post resuscitation left ventricular function and neurological function compared to standard (S) CPR after 15 min of untreated ventricular fibrillation in a porcine model of cardiac arrest.


METHODS
Pigs (n = 22) anesthetized with isoflurane underwent 15 min of untreated ventricular fibrillation, were then randomized to 6 min of S-CPR (n = 11) or SNPeCPR (n = 11) followed by defibrillation. The primary endpoints were neurologic function as measured by cerebral performance category (CPC) score and left ventricular ejection fraction.


RESULTS
SNPeCPR increased 24-hour survival rates compared to S-CPR (10/11 versus 5/11, p = 0.03) and improved neurological function (CPC score 2.5 ± 1, versus 3.8 ± 0.4, respectively, p = 0.004). Left ventricular ejection fractions at 1, 4 and 24 hours after defibrillation were 72 ± 11, 57 ± 11.4 and 64 ± 11 with SNPeCPR versus 29 ± 10, 30 ± 17 and 39 ± 6 with S-CPR, respectively (p < 0.01 for all).


CONCLUSIONS
In this pig model, after 15 min of untreated ventricular fibrillation, SNPeCPR significantly improved 24-hour survival rates, neurologic function and prevented post-resuscitation left ventricular dysfunction compared to S-CPR.
Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55455-0341, USA.
Jason
J
Schultz
Nicolas
N
Segal
James
J
Kolbeck
Emily
E
Caldwell
Marit
M
Thorsgard
Scott
S
McKnite
Tom P
TP
Aufderheide
Keith G
KG
Lurie
Demetris
D
Yannopoulos
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004195:Disease Models, Animal; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D009424:Nervous System Physiological Phenomena; D009599:Nitroprusside / Q000008:administration & dosage*; D013552:Swine; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D014693:Ventricular Fibrillation / Q000150:complications* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*
D014665:Vasodilator Agents; D009599:Nitroprusside