title: Correlation of Impedance Threshold Device use during cardiopulmonary resuscitation with post-cardiac arrest Acute Kidney Injury.
abstract: OBJECTIVE
  To assess whether use of Impedance Threshold Device (ITD) during cardiopulmonary resuscitation (CPR) reduces the degree of post-cardiac arrest Acute Kidney Injury (AKI), as a result of improved hemodynamics, in a porcine model of ventricular fibrillation (VF) cardiac arrest.
  
  
  METHODS
  After 8 min of untreated cardiac arrest, the animals were resuscitated either with active compression-decompression (ACD) CPR plus a sham ITD (control group, n=8) or with ACD-CPR plus an active ITD (ITD group, n=8). Adrenaline was administered every 4 min and electrical defibrillation was attempted every 2 min until return of spontaneous circulation (ROSC) or asystole. After ROSC the animals were monitored for 6 h under general anesthesia and then returned to their cages for a 48 h observation, before euthanasia. Two novel biomarkers, Neutrophil Gelatinase-Associated Lipocalin (NGAL) in plasma and Interleukin-18 (IL-18) in urine, were measured at 2 h, 4 h, 6 h, 24 h and 48 h post-ROSC, in order to assess the degree of AKI.
  
  
  RESULTS
  ROSC was observed in 7 (87.5%) animals treated with the sham valve and 8 (100%) animals treated with the active valve (P=NS). However, more than twice as many animals survived at 48 h in the ITD group (n=8, 100%) compared to the control group (n=3, 37.5%). Urine IL-18 and plasma NGAL levels were augmented post-ROSC in both groups, but they were significantly higher in the control group compared with the ITD group, at all measured time points.
  
  
  CONCLUSIONS
  Use of ITD during ACD-CPR improved hemodynamic parameters, increased 48 h survival and decreased the degree of post-cardiac arrest AKI in the resuscitated animals.
authors.affiliation: National and Kapodistrian University of Athens, Medical School, 3A Parou st, Melissia, Athens 15127, Greece. Electronic address: panifor@gmail.com.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Niforopoulou
authors.affiliation: National and Kapodistrian University of Athens, Medical School, 3 Pavlou Mela st, Athens 16233, Greece. Electronic address: niciac58@gmail.com.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Iacovidou
authors.affiliation: National and Kapodistrian University of Athens, Medical School, Laboratory of Research of the Musculoskeletal System, 10 Athinas st, Kifissia, Athens 14561, Greece. Electronic address: paulveterin@yahoo.com.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Lelovas
authors.affiliation: National and Kapodistrian University of Athens, Medical School, 45-47 Ypsilantou st, Athens 10676, Greece. Electronic address: georgekarlis@yahoo.com.
authors.forename: George
authors.initials: G
authors.lastname: Karlis
authors.affiliation: Experimental-Research Centre, ELPEN Pharmaceutical Co. Inc., 95 Marathonos Ave, Pikermi, Athens 19009, Greece. Electronic address: apapalois@elpen.gr.
authors.forename: Αpostolos
authors.initials: Α
authors.lastname: Papalois
authors.affiliation: National and Kapodistrian University of Athens, Medical School, Academic Department of Gastroenterology, Laikon General Hospital, 17 Aghiou Thoma st, Athens 11527, Greece. Electronic address: s.siakavellas@gmail.com.
authors.forename: Spyros
authors.initials: S
authors.lastname: Siakavellas
authors.affiliation: Hippokrateion General Hospital of Athens, 114 Vassilissis Sofias Ave, Athens, 11527, Greece. Electronic address: vspapis@hotmail.com.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Spapis
authors.affiliation: Aretaieion University Hospital, Biopathology Department, 76 Vassilissis Sofias Ave, Athens 11528, Greece. Electronic address: captenkap@yahoo.gr.
authors.forename: George
authors.initials: G
authors.lastname: Kaparos
authors.affiliation: National and Kapodistrian University of Athens, Medical School, Aretaieion University Hospital, 76 Vassilissis Sofias Ave, Athens 11528, Greece. Electronic address: isiafaka@hotmail.com.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Siafaka
authors.affiliation: European University of Cyprus, School of Medicine, 6 Diogenis str, Engomi, Nicosia 1516, Cyprus. Electronic address: theodorosxanthos@yahoo.com.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xanthos
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications*; D000818:Animals; D015415:Biomarkers / Q000652:urine; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation*; D004195:Disease Models, Animal; D017097:Electric Impedance; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006439:Hemodynamics; D020382:Interleukin-18 / Q000652:urine; D000071068:Lipocalin-2 / Q000652:urine; D008991:Monitoring, Physiologic; D013552:Swine; D014693:Ventricular Fibrillation / Q000628:therapy*
chemical_list: D015415:Biomarkers; D020382:Interleukin-18; D000071068:Lipocalin-2; D004837:Epinephrine
keywords: Acute Kidney Injury; Cardiopulmonary resuscitation; Impedance Threshold Device; Interleukin-18; Neutrophil Gelatinase-Associated Lipocalin; Ventricular fibrillation