Magnetic Resonance Imaging During Untreated Ventricular Fibrillation Reveals Prompt Right Ventricular Overdistention Without Left Ventricular Volume Loss

Berg, Robert A.; Sorrell, Vincent L.; Kern, Karl B.; Hilwig, Ronald W.; Altbach, María I.; Hayes, Melinda M.; Bates, Kathryn; Ewy, Gordon A.

doi:10.1161/01.cir.0000157147.26869.31

Cited by 43 publications

(24 citation statements)

References 29 publications

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“…These volume shifts were shown by Steen in open chest swine, so we evaluated ventricular volume shifts in an intact chest of a swine by magnetic resonance imaging 36. We confirmed the marked increase in RV volume following cardiac arrest, which could contribute to pericardial constriction and cardiac tamponade following untreated cardiac arrest 36…”

Section: New Understanding Of the Pathophysiology Of Primary Cardiac supporting

confidence: 69%

Cardiocerebral and cardiopulmonary resuscitation – 2017 update

Ewy

2017

Acute Medicine & Surgery

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Sudden cardiac arrest is a major public health problem in the industrialized nations of the world. Yet, in spite of recurrent updates of the guidelines for cardiopulmonary resuscitation and emergency cardiac care, many areas have suboptimal survival rates. Cardiocerebral resuscitation, a non‐guidelines approach to therapy of primary cardiac arrest based on our animal research, was instituted in Tucson (AZ, USA) in 2002 and subsequently adopted in other areas of the USA. Survival rates of patients with primary cardiac arrest and a shockable rhythm significantly improved wherever it was adopted. Cardiocerebral resuscitation has three components: the community, the pre‐hospital, and the hospital. The community component emphasizes bystander recognition and chest compression only resuscitation. Its pre‐hospital or emergency medical services component emphasizes: (i) urgent initiation of 200 uninterrupted chest compressions before and after each indicated single defibrillation shock, (ii) delayed endotracheal intubation in favor of passive delivery of oxygen by a non‐rebreather mask, (iii) early adrenaline administration. The hospital component was added later. The national and international guidelines for cardiopulmonary resuscitation and emergency medical services are still not optimal, for several reasons, including the fact that they continue to recommend the same approach for two entirely different etiologies of cardiac arrest: primary cardiac arrest, often caused by ventricular fibrillation, where the arterial blood oxygenation is little changed at the time of the arrest, and secondary cardiac arrest from severe respiratory insufficiency, where the arterial blood is severely desaturated at the time of cardiac arrest. These different etiologies need different approaches to therapy.

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Section: New Understanding Of the Pathophysiology Of Primary Cardiac supporting

confidence: 69%

Cardiocerebral and cardiopulmonary resuscitation – 2017 update

Ewy

2017

Acute Medicine & Surgery

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“…Swine have become the preferred large animal model for both cardiac arrest and myocardial infarct sizing (34). As per the majority of myocardial infarct patients, swine lack developed large coronary collaterals and their coronary territorial distribution is identical to most humans with the left anterior descending coronary feeding the anterior, septal and portion of the lateral left ventricular area (35).…”

Section: Discussionmentioning

confidence: 99%

Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model

Kern

Hanna

Young

et al. 2016

JACC: Cardiovascular Interventions

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“…The interpreter was blinded to the assigned group. The endocardium of the LV and RV was manually traced at each time point and the LV and RV volumes were calculated from the summed total of the individual slice volumes using Simpson's method as previously described [15]. More than 10,000 individual images were analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…The stone heart phenomenon has not been extensively studied in closed-chested, whole animal models of sustained VF. Our laboratory was the first to study stone heart in these animal models with minimal intra-thoracic surgical interventions by using cardiovascular magnetic resonance (CMR) [15,16]. Furthermore, although induced mild hypothermia is a well-established effective therapy for improving neurological outcomes, its effects on early ventricular dilation or late stone heart development, secondary to untreated VF, are unknown.…”

Section: Introductionmentioning

confidence: 99%

Mild hypothermia delays the development of stone heart from untreated sustained ventricular fibrillation - a cardiovascular magnetic resonance study

Sorrell

Paleru

Altbach

et al. 2011

Journal of Cardiovascular Magnetic Resonance

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Background'Stone heart' resulting from ischemic contracture of the myocardium, precludes successful resuscitation from ventricular fibrillation (VF). We hypothesized that mild hypothermia might slow the progression to stone heart.MethodsFourteen swine (27 ± 1 kg) were randomized to normothermia (group I; n = 6) or hypothermia groups (group II; n = 8). Mild hypothermia (34 ± 2°C) was induced with ice packs prior to VF induction. The LV and right ventricular (RV) cross-sectional areas were followed by cardiovascular magnetic resonance until the development of stone heart. A commercial 1.5T GE Signa NV-CV/i scanner was used. Complete anatomic coverage of the heart was acquired using a steady-state free precession (SSFP) pulse sequence gated at baseline prior to VF onset. Un-gated SSFP images were obtained serially after VF induction. The ventricular endocardium was manually traced and LV and RV volumes were calculated at each time point.ResultsIn group I, the LV was dilated compared to baseline at 5 minutes after VF and this remained for 20 minutes. Stone heart, arbitrarily defined as LV volume <1/3 of baseline at the onset of VF, occurred at 29 ± 3 minutes. In group II, there was less early dilation of the LV (p < 0.05) and the development of stone heart was delayed to 52 ± 4 minutes after onset of VF (P < 0.001).ConclusionsIn this closed-chest swine model of prolonged untreated VF, hypothermia reduced the early LV dilatation and importantly, delayed the onset of stone heart thereby extending a known, morphologic limit of resuscitability.

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Magnetic Resonance Imaging During Untreated Ventricular Fibrillation Reveals Prompt Right Ventricular Overdistention Without Left Ventricular Volume Loss

Cited by 43 publications

References 29 publications

Cardiocerebral and cardiopulmonary resuscitation – 2017 update

Cardiocerebral and cardiopulmonary resuscitation – 2017 update

Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model

Mild hypothermia delays the development of stone heart from untreated sustained ventricular fibrillation - a cardiovascular magnetic resonance study

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