Cardiopulmonary Arrest and Resuscitation in Severe Sepsis and Septic Shock

Abstract

Cardiopulmonary resuscitation in patients with severe sepsis and septic shock is challenging and usually unsuccessful. The aim of the present study is to describe our swine model of cardiac arrest and resuscitation in severe sepsis and septic shock. In this prospective randomized animal study, 10 healthy female Landrace-Large White pigs with an average weight of 20 ± 1 kg (aged 19 - 21 weeks) were the study subjects. Septicemia was induced by an intravenous infusion of a bolus of 20-mL bacterial suspension in 2 min, followed by a continuous infusion during the rest of the experiment. After septic shock was confirmed, the animals were left untreated until cardiac arrest occurred. All animals developed pulseless electrical activity between the fifth and sixth hours of septicemia, whereas five (50%) of 10 animals were successfully resuscitated. Coronary perfusion pressure was statistically significantly different between surviving and nonsurviving animals. We found a statistically significant correlation between mean arterial pressure and unsuccessful resuscitation (P = 0.046), whereas there was no difference in end-tidal carbon dioxide (23.05 ± 1.73 vs. 23.56 ± 1.70; P = 0.735) between animals with return of spontaneous circulation and nonsurviving animals. During the 45-min postresuscitation monitoring, we noted a significant decrease in hemodynamic parameters, although oxygenation indices and lactate clearance were constantly increased (P = 0.001). This successful basic swine model was for the first time developed and may prove extremely useful in future studies on the periarrest period in severe sepsis and septic shock.

The Systemic Alterations of Lipids, Alanine-Glucose Cycle and Inter-Organ Amino Acid Metabolism in Swine Model Confirms the Role of Liver in Early Phase of Septic Shock

“…Several swine models of sepsis and septic shock have been developed to mimic the human disease progression and clinical settings by utilizing standard clinical treatments such as fluid resuscitation, antibiotics, and mechanical ventilation (Kubiak et al, 2011; Li et al, 2013; Revie et al, 2013; Corrêa et al, 2014; Chalkias et al, 2015; Vassal et al, 2015; Zhao et al, 2015; Duburcq et al, 2017). However, critiques on the relevance of experimental data regarding the translation to clinical sepsis/septic shock have been raised in the scientific community (Piper et al, 1996; Deitch, 1998; Esmon, 2004; Dyson and Singer, 2009; Opal and Patrozou, 2009).…”

The effects of n-acetylcysteine and desferoxamine on IL-6, TNF-a, and oxLDL after infrarenal aortic clamping

“…Thiopental infusion of 5 mg/kg/hr and additional doses of cis-atracurium at 20 μg/kg/min and fentanyl at 0.6 μg/kg/min were given to maintain adequate anaesthetic depth. Fluid infusion of 2 ml/kg/h isotonic sodium chloride was started and remained constant throughout the experiment in order to prevent an artificial stress response [5].…”

Assessment of Post-Resuscitation Intestinal Injury and Timing of Bacterial Translocation in Swine Anaesthetized With Propofol-Based Total Intravenous Anaesthesia

“…The animals were subsequently transported to the operation research facility and intravascular access through the auricular veins was obtained. Anaesthesia was induced by an intravenous bolus dose of 2 mg/kg propofol (Diprivan 1% w/v; Astra Zeneca, Luton, United Kingdom) and 2 μg/kg fentanyl (Janssen Pharmaceutica, Beerse, Belgium) [10]. Whilst spontaneously breathing but anaesthetized, the animals were intubated with an endotracheal tube (Portex, 4.5 mm ID; Mallinckrodt Medical, Athlone, Ireland) and were immobilized in the supine position on a surgical For measurement of the aortic pressures, an arterial catheter (model 6523, USCI CR, Bart; Papapostolou) was inserted and forwarded into the descending aorta after surgical preparation of the right internal carotid artery.…”