Mechanical Ventilation During Cardiopulmonary Resuscitation With Intermittent Positive-Pressure Ventilation, Bilevel Ventilation, or Chest Compression Synchronized Ventilation in a Pig Model*

Kill, Clemens; Hahn, Oliver; Dietz, Florian; Neuhaus, Christian; Schwarz, Štefan; Mahling, Robert; Wallot, Pascal; Jerrentrup, Andreas; Steinfeldt, Thorsten; Wulf, Hinnerk; Dersch, Wolfgang

doi:10.1097/ccm.0b013e3182a63fa0

Cited by 49 publications

(35 citation statements)

References 29 publications

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“…Although there have been a number of animal studies 79,[81][82][83][84][85][86][87][88][89] and 1 human observational study 90 evaluating ventilation rates during CPR, the design and data from these studies did not allow for the assessment of the effect of a…”

Section: Evidence Summarymentioning

confidence: 99%

Part 7: Adult Advanced Cardiovascular Life Support

Link¹,

Berkow²,

Kudenchuk³

et al. 2015

Circulation

1,049

429

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Section: Evidence Summarymentioning

confidence: 99%

Part 7: Adult Advanced Cardiovascular Life Support

Link¹,

Berkow²,

Kudenchuk³

et al. 2015

Circulation

1,049

429

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“…We identified very-low-quality evidence (downgraded for very serious risk of bias and indirectness, and serious inconsistency and imprecision) from 10 animal studies [54][55][56][57][58][59][60][61][62][63] and 1 human observational study 64 that does not enable us to estimate with confidence the effect of a ventilation rate of 10/ min compared with any other rate for the important outcome of ROSC.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

554

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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“…In the event of prolonged VF, VT without ROSC or another episode of VT or VF after achieved ROSC, the respective study drug was given again in half of the initial dosage (amiodarone 2.5 mg kg −1 (Cordarex, Sanofi Aventis, Frankfurt, Germany, solved in 5% glucose solution according to the manufacturer’s recommendation), dantrolene 2.5 mg kg −1 (Dantrolen IV, Norgine, Marburg, Germany, solved in water for injection as delivered by the manufacturer) or isotonic saline infusion (NaCl, B. Braun, Melsungen, Germany) according to current CPR guidelines56. If ROSC was not achieved after four defibrillation cycles, no further CPR attempts were made.…”

Section: Methodsmentioning

confidence: 99%

Dantrolene versus amiodarone for cardiopulmonary resuscitation: a randomized, double-blinded experimental study

Wiesmann

Freitag

Dersch

et al. 2017

Sci Rep

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Dantrolene was introduced for treatment of malignant hyperthermia. It also has antiarrhythmic properties and may thus be an alternative to amiodarone for the treatment of ventricular fibrillation (VF). Aim of this study was to compare the return of spontaneous circulation (ROSC) with dantrolene and amiodarone in a pig model of cardiac arrest. VF was induced in anesthetized pigs. After 8 min of untreated VF, chest compressions and ventilation were started and one of the drugs (amiodarone 5 mg kg−1, dantrolene 2.5 mg kg−1 or saline) was applied. After 4 min of initial CPR, defibrillation was attempted. ROSC rates, hemodynamics and cerebral perfusion measurements were measured. Initial ROSC rates were 7 of 14 animals in the dantrolene group vs. 5 of 14 for amiodarone, and 3 of 10 for saline). ROSC persisted for the 120 min follow-up in 6 animals in the dantrolene group, 4 after amiodarone and 2 in the saline group (n.s.). Hemodynamics were comparable in both dantrolene group amiodarone group after obtaining ROSC. Dantrolene and amiodarone had similar outcomes in our model of prolonged cardiac arrest, However, hemodynamic stability was not significantly improved using dantrolene. Dantrolene might be an alternative drug for resuscitation and should be further investigated.

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Mechanical Ventilation During Cardiopulmonary Resuscitation With Intermittent Positive-Pressure Ventilation, Bilevel Ventilation, or Chest Compression Synchronized Ventilation in a Pig Model*

Cited by 49 publications

References 29 publications

Part 7: Adult Advanced Cardiovascular Life Support

Part 7: Adult Advanced Cardiovascular Life Support

Part 4: Advanced Life Support

Dantrolene versus amiodarone for cardiopulmonary resuscitation: a randomized, double-blinded experimental study

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