Myocardial perfusion pressure: A predictor of 24-hour survival during prolonged cardiac arrest in dogs

Abstract

Myocardial perfusion pressure, defined as the aortic diastolic pressure minus the right atria1 diastolic pressure, correlates with coronary blood flow during cardiopulmonary resuscitation (CPR) and predicts initial resuscitation success. Whether this hemodynamic parameter can predict 24-h survival is not known. We examined the relationship between myocardial perfusion pressure and 24-h survival in 60 dogs that underwent prolonged (20 min) ventricular fibrillation and CPR. Forty-two (70%) animals were initially resuscitated and 20 (33%) survived for 24 h. Myocardial perfusion pressure was significantly greater when measured at 5, 10, 15 and 20 min of ventricular fibrillation in the resuscitated animals than in the non-resuscitated animals (P < 0.01). Likewise, the myocardial perfusion pressure was also greater in the animals that survived 24 h than in animals that were resuscitated, but died before 24 h (P < 0.02). Myocardial perfusion pressure measured after 10 min of CPR was 11  2 mmHg in animals never resuscitated, 20  3 mmHg in those resuscitated that died before 24 h and 29  2 mmHg in those that survived 24 h (P < 0.05). A myocardial perfusion pressure at 10 min of CPR of 20 mmHg or less is an excellent predictor of poor survival (negative predictive value = 96%). Myocardial perfusion pressure is a useful index of CPR effectiveness and therefore may be a useful guide in helping to optimize resuscitation efforts.

Cardiopulmonary resuscitation in a swine model of cardiac arrest

“…Η ΠΠΣΑ, η οποία είναι υπεύθυ νη για την αιμάτωση του μυοκαρδίου, αυξάνεται κατά τη διάρκεια των θωρακικών συμπιέσεων (Paradis et al 1990). Η ανάκτηση της αυτόματης κυκλοφορίας και η επιβίωση μετά από επεισόδιο ΚΑ έχει συσχετιστεί με τιμές ΠΣΣΑ> 15mmHg για τους ανθρώπους (Paradis et al 1990) και >25 mmHg για τα ζώα (Kern et al 1988).…”

Is There Still a Place for Vasopressors in the Treatment of Cardiac Arrest?

“…Th e importance of maintaining an adequate coronary perfusion pressure during CPR has been highlighted in animal and human studies. Kern et al [6] showed that a coronary perfusion pressure < 20 mmHg measured after 20 minutes of CPR was associated with poor survival in dogs with VF. Brown et al [7] found a positive association between myocardial blood fl ow and defi brillation rates in a swine model of VF.…”

“…Animal studies [6,7] have demonstrated that epinephrine increases both myocardial and cerebral blood fl ow during CPR, and facilitates ROSC.…”

Vasopressors for cardiopulmonary resuscitation

“…Aortic diastolic pressure, an important determinant of coronary blood-flow is increased (Michael et al 1984;Brown and Werman 1990). Maintenance of coronary blood-flow is the most important factor in enabling return of spontaneous circulation (ROSC) or successful defibrillation (Kern et al 1988;Paradis et al 1990;Paradis et al 1991;Babbs et al 2001;Zhong and Dorian 2005) It is interesting to note that one historical resuscitation method was to throw cold water at the face of the victim. (Hermreck 1988).…”

“…Endpoints in experimental models have included ROSC (Hilwig et al 2000), 24 hr survival (Kern et al 1988;Hilwig et al 2000), coronary perfusion pressure (Kolarova et al 2005) and ventricular ectopic activity (arrhythmias) (Kolarova et al 2005). …”