title: Reperfusion injury protection during Basic Life Support improves circulation and survival outcomes in a porcine model of prolonged cardiac arrest.
abstract: Ischemic postconditioning (PC) using three intentional pauses at the start of cardiopulmonary resuscitation (CPR) improves outcomes after cardiac arrest in pigs when epinephrine (epi) is used before defibrillation. We hypothesized PC, performed during basic life support (BLS) in the absence of epinephrine, would reduce reperfusion injury and enhance 24h functional recovery.
  
  
  
  Prospective animal investigation.
  
  
  
  Animal laboratory
  
  
  
  Female farm pigs (n=46, 39±1kg).
  
  
  
  Protocol A: After 12min of ventricular fibrillation (VF), 28 pigs were randomized to four groups: (A) Standard CPR (SCPR), (B) active compression-decompression CPR with an impedance threshold device (ACD-ITD), (C) SCPR+PC (SCPR+PC) and (D) ACD-ITD CPR+PC. Protocol B: After 15min of VF, 18 pigs were randomized to ACD-ITD CPR or ACD-ITD+PC. The BLS duration was 2.75min in Protocol A and 5min in Protocol B. Following BLS, up to three shocks were delivered. Without return of spontaneous circulation (ROSC), CPR was resumed and epi (0.5mg) and defibrillation delivered. The primary end point was survival without major adverse events. Hemodynamic parameters and left ventricular ejection fraction (LVEF) were also measured. Data are presented as mean±SEM.
  
  
  
  Protocol A: ACD-ITD+PC (group D) improved coronary perfusion pressure after 3min of BLS versus the three other groups (28±6, 35±7, 23±5 and 47±7 for groups A, B, C, D respectively, p=0.05). There were no significant differences in 24h survival between groups.
  
  
  
  LVEF 4h post ROSC was significantly higher with ACD-ITD+PC vs ACD-ITD alone (52.5±3% vs. 37.5±6.6%, p=0.045). Survival rates were significantly higher with ACD-ITD+PC vs. ACD-ITD alone (p=0.027).
  
  
  
  BLS using ACD-ITD+PC reduced post resuscitation cardiac dysfunction and improved functional recovery after prolonged untreated VF in pigs.
  
  
  
  12-11.
authors.affiliation: Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA; University Grenoble Alps/CNRS/CHU de Grenoble/TIMC-IMAG UMR 5525, Grenoble, France. Electronic address: gdebaty@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Lurie
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Anja
authors.initials: A
authors.lastname: Metzger
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lick
authors.affiliation: Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Bartos
authors.affiliation: Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Rees
authors.affiliation: Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: McKnite
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Puertas
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8579, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Pepe
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8579, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Fowler
authors.affiliation: Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
mesh_terms: D000818:Animals; D001775:Blood Circulation; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D004195:Disease Models, Animal; D004554:Electric Countershock / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D057775:Ischemic Postconditioning / Q000379:methods*; D011446:Prospective Studies; D011897:Random Allocation; D015427:Reperfusion Injury / Q000517:prevention & control*; D013552:Swine; D013566:Sympathomimetics / Q000008:administration & dosage; D013997:Time Factors
chemical_list: D013566:Sympathomimetics; D004837:Epinephrine
keywords: Active compression decompression; Basic life support; Cardiac arrest; Cardiopulmonary resuscitation; Impedance threshold device; Ischemic postconditioning