A randomized comparison of cardiocerebral and cardiopulmonary resuscitation using a swine model of prolonged ventricular fibrillation

Mader, Timothy J.; Kellogg, Adam; Walterscheid, Joshua K.; Lodding, Cynthia C.; Sherman, Lawrence

doi:10.1016/j.resuscitation.2010.01.013

Cited by 24 publications

(18 citation statements)

References 43 publications

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“…We must acknowledge that vascular access established during preparation phase of the experiment via the femoral vein was used for SDE delivery rather than a peripheral IV, which may have skewed the data in favor of the SDE IV group. Use of an auricular vein in this model might be a more clinically relevant comparator, though from our previous work we note that HDE through the femoral vein resulted in a peak CPP of 34.8 mmHg (95%CI: 25.2, 44.5), values quite similar to the HDE IO group in this study [5]. This does however raise concerns regarding the appropriateness of the SDE IV dosage recommendation in the metabolic phase of cardiac arrest, and its ability when delivered peripherally to generate adequate CPP sufficient for defibrillation success, ROSC, and short-term survival in a substantial number of OHCA victims.…”

Section: Discussionsupporting

confidence: 72%

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Coronary Perfusion Pressure Response to High-Dose Intraosseous versus Standard-Dose Intravenous Epinephrine Administration after Prolonged Cardiac Arrest

Mader¹,

Coute²,

Kellogg³

et al. 2014

OJEM

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Background: This study was done to compare coronary perfusion pressure (CPP) prior to the first rescue shock (RS) among a group of animals that received intraosseous (IO) epinephrine 0.1 mg/ kg (high-dose epinephrine [HDE]) with a group that received intravenous (IV) epinephrine 0.01 mg/kg (standard-dose epinephrine [SDE]) during cardiac arrest resuscitation using a swine model of prolonged out-of-hospital ventricular fibrillation (VF) cardiac arrest. Methods: This was a secondary analysis of prospectively collected data from two IACUC approved protocols. Seventy-nine Yorkshire swine (25-35 kg) were surgically instrumented under anesthesia and VF was electrically induced. After 10 minutes of untreated VF in the IO study (n = 26) and 12 minutes of untreated VF in the IV study (n = 53), resuscitation commenced with closed chest compressions (CCC). A single dose of epinephrine (HDE IO or SDE IV, respectively) was given and flushed with saline. The CCC and RS attempts were standardized for all animals. The CPP was defined as aortic diastolic pressure minus right atrial diastolic pressure measured 2.5 minutes after medication delivery. Descriptive statistics were used to analyze the data. Results: Baseline group characteristics were mathematically the same. Just prior to the first RS, HDE IO resulted in a mean CPP of 33.2 mmHg (95%CI: 26.6, 39.9), while SDE IV resulted in a mean CPP of 25.0 mmHg (95%CI: 20.5, 29.4). Conclusion: This observation study reaffirms the assertion that HDE IO may be required to generate CPP values similar to SDE IV during resuscitation of prolonged VF.

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Section: Discussionsupporting

confidence: 72%

“…Animals were delivered and acclimated in advance of use. Our standard animal preparation and resuscitation procedures have been previously described in detail [4] [5].…”

Section: Methodsmentioning

confidence: 99%

Coronary Perfusion Pressure Response to High-Dose Intraosseous versus Standard-Dose Intravenous Epinephrine Administration after Prolonged Cardiac Arrest

Mader¹,

Coute²,

Kellogg³

et al. 2014

OJEM

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“…For treatment of ventricular fibrillation in a pig model, Mader et al found that epinephrine was more quickly administered via IO (0.84 minutes) than by peripheral IV (6.68 min); the 20 min survival rate was also higher in their IO group (21 of 26 survivors vs 16 of 27 survivors) [20]. In a study of the IO infusion of normal saline versus a hydroxycobalamin solution, Borron et al found no significant differences in heart rates in a goat model [21].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Intraosseous Blood and Ringer Lactate in a Rabbit Model of Hemorrhagic Hypovolemia

Korkmaz¹

2013

CMR

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Purpose: In this study, flow rates of intraosseously (IO) or intravenously (IV) administered fluids (blood orRinger lactate) and their effects on vital signs were examined in a rabbit model of hypovolemia. Methods: Underanesthesia, 20 mL of blood was removed from each of the 36 New Zealand-type rabbits. Ten minutes later, each group of nine rabbits received one of four fluids by gravity flow from a height of 100 cm: blood via IO, Ringer Laktat (RL) via IO, blood via IV, or RL via IV. IO fluids were given in the proximal tibia through a 15 g needle placed with an EZ-IO instrument; IV fluids were given through a 22g catheter in the femoral vein. Vital signs were monitored for four hours after the infusion ended. Results: Flow rates were blood IO 2.6 mL/min, RL IO 3.4 mL/min, blood IV 3.2 mL/min, and RL IV 11.8 mL/min. Ten minutes after fluid administration ended, in the RL via IO group, heart rate was significantly slower than preinfusion; in the blood via IO group, body temperature was significantly lower than preinfusion, and in the blood via IO group, StO2 saturation was higher than preinfusion. Postinfusion respiratory rates within groups were not significantly different than preinfusion rates. Vital sign changes between groups were not significantly different. Conclusion: Fluids given by gravity feed through an IO needle were effective in treating hypovolemia in this rabbit model, but the flow of RL and blood were significantly slower through the 15g IO needle than the 22g IV catheter.

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“…A total of 105 female Yorkshire swine (weighing 30 -35 kg) were included. From the first study, data from both the experimental (Group A [n = 26]) and control (Group B [n = 26]) groups were used because the groups were similarly treated [18]. From the second study, only the animals in the control group (Group C [n = 53]) were included because the treatment (n = 27) group received non-standard resuscitation medications that differed substantially from the other 3 groups.…”

Section: Methodsmentioning

confidence: 99%

“…The animal preparation methods for these experiments have been previously described in detail [18]. In both studies, animals were instrumented under general anesthesia after an intramuscular TKX [telazol (5 mg/kg), ketamine (2.5 mg/kg), and xylazine (2.5 mg/kg)] for sedation.…”

Section: Methodsmentioning

confidence: 99%

Restoring Coronary Perfusion Pressure before Defibrillation after Chest Compression Interruptions

Mader¹,

Coute²,

Kellogg³

et al. 2014

OJEM

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Background: Sufficient coronary perfusion pressure (CPP) to provide myocardial reperfusion is required for defibrillation success after prolonged ventricular fibrillation (VF) cardiac arrest. Chest compression interruptions cause a precipitous drop in CPP. Objective: To quantify the extent to which CPP recovers to pre-pause levels following chest compression interruptions. Methods: This was a secondary analysis of data from two similar IACUC approved protocols. A total of 105 Yorkshire swine were included and VF was electrically induced. After 10 minutes of untreated VF in the first study (n = 52) and 12 minutes of untreated VF in the second (n = 53), CPR began and epinephrine was administered approximately 2 minutes prior to a planned 10-second pause to record an artifact-free ECG waveform segment. Following this pause, CPR was resumed for 20seconds prior to defibrillation. CPP data were extracted from three time points: 2 minutes after epinephrine delivery (CPP1); following the chest compression pause (CPP2); and immediately before defibrillation (CPP3). Our primary outcome was defined as the ratio of CPP recovery (CPP3-CPP2) to the drop in CPP (CPP1-CPP2). Results: Interrupting compressions resulted in a significant drop in CPP (29.8 mmHg [95%CI: 26.2, 33.4] to 6.8 mmHg [95%CI: 5.4, 8.2]). Resuming CPR for restored 83% (95%CI: 78%, 86%) of the CPP lost. Conclusion: This study demonstrates that 83% of the decline in CPP values during a planned 10-second interruption in CPR can be restored with a short period of precordial compressions prior to defibrillation.

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A randomized comparison of cardiocerebral and cardiopulmonary resuscitation using a swine model of prolonged ventricular fibrillation

Cited by 24 publications

References 43 publications

Coronary Perfusion Pressure Response to High-Dose Intraosseous versus Standard-Dose Intravenous Epinephrine Administration after Prolonged Cardiac Arrest

Coronary Perfusion Pressure Response to High-Dose Intraosseous versus Standard-Dose Intravenous Epinephrine Administration after Prolonged Cardiac Arrest

The Efficacy of Intraosseous Blood and Ringer Lactate in a Rabbit Model of Hemorrhagic Hypovolemia

Restoring Coronary Perfusion Pressure before Defibrillation after Chest Compression Interruptions

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