title: Enhanced perfusion during advanced life support improves survival with favorable neurologic function in a porcine model of refractory cardiac arrest.
abstract: OBJECTIVE
  To improve the likelihood for survival with favorable neurologic function after cardiac arrest, we assessed a new advanced life support approach using active compression-decompression cardiopulmonary resuscitation plus an intrathoracic pressure regulator.
  
  
  METHODS
  Prospective animal investigation.
  
  
  METHODS
  Animal laboratory.
  
  
  METHODS
  Female farm pigs (n = 25) (39 ± 3 kg).
  
  
  METHODS
  Protocol A: After 12 minutes of untreated ventricular fibrillation, 18 pigs were randomized to group A-3 minutes of basic life support with standard cardiopulmonary resuscitation, defibrillation, and if needed 2 minutes of advanced life support with standard cardiopulmonary resuscitation; group B-3 minutes of basic life support with standard cardiopulmonary resuscitation, defibrillation, and if needed 2 minutes of advanced life support with active compression-decompression plus intrathoracic pressure regulator; and group C-3 minutes of basic life support with active compression-decompression cardiopulmonary resuscitation plus an impedance threshold device, defibrillation, and if needed 2 minutes of advanced life support with active compression-decompression plus intrathoracic pressure regulator. Advanced life support always included IV epinephrine (0.05 μg/kg). The primary endpoint was the 24-hour Cerebral Performance Category score. Protocol B: Myocardial and cerebral blood flow were measured in seven pigs before ventricular fibrillation and then following 6 minutes of untreated ventricular fibrillation during sequential 5 minutes treatments with active compression-decompression plus impedance threshold device, active compression-decompression plus intrathoracic pressure regulator, and active compression-decompression plus intrathoracic pressure regulator plus epinephrine.
  
  
  RESULTS
  Protocol A: One of six pigs survived for 24 hours in group A versus six of six in groups B and C (p = 0.002) and Cerebral Performance Category scores were 4.7 ± 0.8, 1.7 ± 0.8, and 1.0 ± 0, respectively (p = 0.001). Protocol B: Brain blood flow was significantly higher with active compression-decompression plus intrathoracic pressure regulator compared with active compression-decompression plus impedance threshold device (0.39 ± 0.23 vs 0.27 ± 0.14 mL/min/g; p = 0.03), whereas differences in myocardial perfusion were not statistically significant (0.65 ± 0.81 vs 0.42 ± 0.36 mL/min/g; p = 0.23). Brain and myocardial blood flow with active compression-decompression plus intrathoracic pressure regulator plus epinephrine were significantly increased versus active compression-decompression plus impedance threshold device (0.40 ± 0.22 and 0.84 ± 0.60 mL/min/g; p = 0.02 for both).
  
  
  CONCLUSIONS
  Advanced life support with active compression-decompression plus intrathoracic pressure regulator significantly improved cerebral perfusion and 24-hour survival with favorable neurologic function. These findings support further evaluation of this new advanced life support methodology in humans.
authors.affiliation: 1Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN. 2UJF-Grenoble 1/CNRS/CHU de Grenoble/TIMC-IMAG UMR 5525, Grenoble, France. 3Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.forename: Anja
authors.initials: A
authors.lastname: Metzger
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rees
authors.forename: Scott
authors.initials: S
authors.lastname: McKnite
authors.forename: Laura
authors.initials: L
authors.lastname: Puertas
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
authors.forename: Keith
authors.initials: K
authors.lastname: Lurie
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002560:Cerebrovascular Circulation; D003326:Coronary Circulation; D004554:Electric Countershock; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006439:Hemodynamics; D008020:Life Support Care / Q000379:methods*; D009422:Nervous System Diseases / Q000517:prevention & control*; D011446:Prospective Studies; D015424:Reperfusion / Q000379:methods*; D013552:Swine