Enhanced external counterpulsation improves cerebral blood flow following cardiopulmonary resuscitation.
BACKGROUND
To investigate the therapeutic value of enhanced external counterpulsation (EECP) on recovery of cerebral blood flow following cardiac arrest (CA) and successful resumption of spontaneous circulation (ROSC) by cardiopulmonary resuscitation.


METHODS
CA models were conducted using beagle dogs induced by alternating current. After successful ROSC by cardiopulmonary resuscitation, 16 dogs were randomly divided into the EECP and control group (n = 8 per group). Dogs underwent dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging at baseline prior to CA and during the 3 days following ROSC. Mean blood pressure, right common carotid artery blood flow, intracranial microcirculation and blood lactate levels were measured. Neurological outcome was assessed by the neurologic deficit score. Hematoxylin-eosin staining and transmission electron microscopy were performed for morphology and microconstruction of the cerebral cortex.


RESULTS
The EECP group exhibited a significant elevation in right common carotid artery blood flow, intracranial microcirculation and a substantial decrease in blood lactate levels relative to the control group. Relative cerebral blood flow and volume were higher in the EECP group during the 3 days. Apparent diffusion coefficients were significantly higher in the EECP group on the first and third days. After ROSC, the neurologic deficit score was significantly higher in the control group compared to those in the EECP group during the three days of experiment. The cell swelling of neurons and increase of mitochondrial mass were more pronounced in the control group.


CONCLUSIONS
EECP is beneficial for recovery of cerebral blood flow and attenuation of ischemic cerebral edema following CA and successful ROSC.
Department of Emergency, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
Rong
R
Liu
Zi-Jing
ZJ
Liang
Xiao-Xing
XX
Liao
Chun-Lin
CL
Hu
Li
L
Jiang
Gang
G
Dai
Ying-Qing
YQ
Li
Hong-Yan
HY
Wei
Gui-Fu
GF
Wu
Xin
X
Li
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D017536:Carotid Artery, Common / Q000502:physiology; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000098:blood supply* / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015908:Counterpulsation / Q000379:methods*; D004285:Dogs; D006323:Heart Arrest / Q000097:blood / Q000628:therapy*; D006439:Hemodynamics; D019344:Lactic Acid / Q000097:blood; D008279:Magnetic Resonance Imaging; D008833:Microcirculation / Q000502:physiology; D046529:Microscopy, Electron, Transmission; D011897:Random Allocation
D019344:Lactic Acid
ADC; CA; CPR; CT; DCE-MRI; DW-MRI; EECP; EPI; FOV; Gd-DTPA; MBP; MQ; MRI; MTT; RCBF; RCBV; RCCA; ROIs; ROSC; SE; TE; TICs; TR; TTP; VF; apparent diffusion coefficient; cardiac arrest; cardiopulmonary resuscitation; computed tomography; diffusion-weighted MRI; dynamic contrast-enhanced MRI; echo-planar imaging; enhanced external counterpulsation; field of view; gadolinium diethylenetriamine pentaacetic acid; magnetic resonance imaging; mean blood pressure; mean quantity; mean transit time; regions of interest; relative cerebral blood flow; relative cerebral blood volume; resumption of spontaneous circulation; return of spontaneous circulation; right common carotid artery; spin echo; time of echo; time of repetition; time to peak; time-intensity curves; ventricular fibrillation