title: Sodium nitroprusside enhanced cardiopulmonary resuscitation improves short term survival in a porcine model of ischemic refractory ventricular fibrillation.
abstract: Sodium nitroprusside (SNP) enhanced CPR (SNPeCPR) demonstrates increased vital organ blood flow and survival in multiple porcine models. We developed a new, coronary occlusion/ischemia model of prolonged resuscitation, mimicking the majority of out-of-hospital cardiac arrests presenting with shockable rhythms.
  
  
  
  SNPeCPR will increase short term (4-h) survival compared to standard 2015 Advanced Cardiac Life Support (ACLS) guidelines in an ischemic refractory ventricular fibrillation (VF), prolonged CPR model.
  
  
  
  Sixteen anesthetized pigs had the ostial left anterior descending artery occluded leading to ischemic VF arrest. VF was untreated for 5min. Basic life support was performed for 10min. At minute 10 (EMS arrival), animals received either SNPeCPR (n=8) or standard ACLS (n=8). Defibrillation (200J) occurred every 3min. CPR continued for a total of 45min, then the balloon was deflated simulating revascularization. CPR continued until return of spontaneous circulation (ROSC) or a total of 60min, if unsuccessful. SNPeCPR animals received 2mg of SNP at minute 10 followed by 1mg every 5min until ROSC. Standard ACLS animals received 0.5mg epinephrine every 5min until ROSC. Primary endpoints were ROSC and 4-h survival.
  
  
  
  All SNPeCPR animals (8/8) achieved sustained ROSC versus 2/8 standard ACLS animals within one hour of resuscitation (p=0.04). The 4-h survival was significantly improved with SNPeCPR compared to standard ACLS, 7/8 versus 1/8 respectively, p=0.0019.
  
  
  
  SNPeCPR significantly improved ROSC and 4-h survival compared with standard ACLS CPR in a porcine model of prolonged ischemic, refractory VF cardiac arrest.
authors: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States. Electronic address: yanno001@umn.edu.
authors: Demetris
authors: D
authors: Yannopoulos
authors: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States.
authors: Jason A
authors: JA
authors: Bartos
authors: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States.
authors: Stephen A
authors: SA
authors: George
authors: Department of Cardiology, Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France.
authors: George
authors: G
authors: Sideris
authors: Department of Cardiology, Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France.
authors: Sebastian
authors: S
authors: Voicu
authors: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States.
authors: Brett
authors: B
authors: Oestreich
authors: Department of Integrated Biology & Physiology, University of Minnesota, Minneapolis, MN, United States.
authors: Timothy
authors: T
authors: Matsuura
authors: Department of Integrated Biology & Physiology, University of Minnesota, Minneapolis, MN, United States.
authors: Kadambari
authors: K
authors: Shekar
authors: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States.
authors: Jennifer
authors: J
authors: Rees
authors: Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
authors: Tom P
authors: TP
authors: Aufderheide
mesh_terms: D022561:Advanced Cardiac Life Support / Q000379:methods / Q000401:mortality; D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004195:Disease Models, Animal; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D004554:Electric Countershock / Q000379:methods; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D009599:Nitroprusside / Q000008:administration & dosage*; D012039:Regional Blood Flow / Q000187:drug effects*; D016019:Survival Analysis; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage; D014693:Ventricular Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000628:therapy
chemical_list: D014665:Vasodilator Agents; D009599:Nitroprusside
keywords: Advanced cardiopulmonary life support; Cardiac arrest; Cardiopulmonary resuscitation; Ischemic refractory ventricular fibrillation; Sodium nitroprusside enhanced CPR; Ventricular fibrillation