Use of CPR in hemorrhagic shock, a dog model

Jeffcoach, David R.; Gallegos, Juan; Jesty, Sophy A.; Coan, Patricia N.; Chen, Jason; Heidel, R. Eric; Daley, Brian

doi:10.1097/ta.0000000000001001

Cited by 19 publications

(14 citation statements)

References 15 publications

(12 reference statements)

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“…A more recent study using a canine model of pulseless electrical activity in TCA found no benefit of chest compressions over fluid therapy alone or fluid combined with chest compressions; in fact the chest compression only group had worse survival, base deficit and ejection fraction. 15 The authors concluded that further research was required to determine whether CPR has a role for the patient in haemorrhagic shock. Our study complements previous work as the injury severity was higher (lower MAP at onset of resuscitation greater degree of shock) as well as including different fluid therapies (crystalloid and blood).…”

Section: Discussionmentioning

confidence: 99%

Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest

et al. 2019

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Closed chest compressions (CCC) are recommended for medical cardiac arrest, but there is little evidence to support their inclusion for traumatic cardiac arrest (TCA). This laboratory study evaluated CCC following haemorrhage-induced TCA and whether resuscitation with blood improved survival compared to saline.The study was conducted with the authority of UK Animals (Scientific Procedures) Act 1986 (received institutional ethical approval and a Home Office Licence) using 39 terminally anesthetised, instrumented, juvenile Large White pigs. Following baseline measurements, animals underwent captive bolt injury to the right thigh and controlled haemorrhage (30% blood volume). Sixty minutes later there was a further haemorrhage to a MAP of 20 mmHg. The randomised resuscitation protocol was initiated within 5 min: CCC (Group 1); IV whole blood (Group 2); IV 0.9% saline (Group 3); IV whole blood + CCC (Group 4); and IV saline + CCC (Group 5). Fluid was administered as 3 Â 10 ml/kg boluses using the Belmont 1 Rapid Infuser. The LUCAS TM II Chest Compression System delivered CCC. Primary Outcome was attainment of return of spontaneous circulation (ROSC MAP ! 50 mmHg) at Study End (fifteen minutes post-resuscitation) and secondary outcomes included haemodynamics.Mortality (MAP 10 mmHg) was significantly higher in Group 1 compared to Groups 2 and 3 (P < 0.0001). Resuscitation with whole blood was significantly better than saline (P = 0.0069), no animals in Group 3 attained ROSC. The addition of chest compressions to fluid resuscitation resulted in a significantly worse outcome with saline resuscitation (P = 0.0023) but not with whole blood (P = 0.4411). Cardiovascular variables at the end of the Resuscitation Phase and Study End were significantly worse for Group 5 compared to Group 3. Some significant differences were present at the end of the Resuscitation Phase for Group 4 versus Group 2 but these differences were no longer present by Study End.CCC were associated with increased mortality and compromised haemodynamics compared to intravenous fluid resuscitation. Whole blood resuscitation was better than saline.

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Section: Discussionmentioning

confidence: 99%

Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest

et al. 2019

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“…Other systemic consequences and effects are dependent on the proportion of volume lost, duration of ongoing bleeding, and individual patient factors regarding compensatory reserve ( Table 2 ). While impacted by the rate of loss, in dogs, cardiac arrest occurs when ~60–90% of blood is lost ( 24 , 25 ) or mean arterial pressure (MAP) falls below 30–40 mmHg ( 13 ).…”

Section: Physiologic and Pathophysiologic Considerationsmentioning

confidence: 99%

Volume Resuscitation in the Acutely Hemorrhaging Patient: Historic Use to Current Applications

Hall

Drobatz

2021

Front. Vet. Sci.

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Acute hemorrhage in small animals results from traumatic and non-traumatic causes. This review seeks to describe current understanding of the resuscitation of the acutely hemorrhaging small animal (dog and cat) veterinary patient through evaluation of pre-clinical canine models of hemorrhage and resuscitation, clinical research in dogs and cats, and selected extrapolation from human medicine. The physiologic dose and response to whole blood loss in the canine patient is repeatable both in anesthetized and awake animals and is primarily characterized clinically by increased heart rate, decreased systolic blood pressure, and increased shock index and biochemically by increased lactate and lower base excess. Previously, initial resuscitation in these patients included immediate volume support with crystalloid and/or colloid, regardless of total volume, with a target to replace lost vascular volume and bring blood pressure back to normal. Newer research now supports prioritizing hemorrhage control in conjunction with judicious crystalloid administration followed by early consideration for administration of platelets, plasma and red blood during the resuscitation phase. This approach minimizes blood loss, ameliorates coagulopathy, restores oxygen delivery and correct changes in the glycocalyx. There are many hurdles in the application of this approach in clinical veterinary medicine including the speed with which the bleeding source is controlled and the rapid availability of blood component therapy. Recommendations regarding the clinical approach to volume resuscitation in the acutely hemorrhaging veterinary patient are made based on the canine pre-clinical, veterinary clinical and human literature reviewed.

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“…Since the rst of January 2004, each case of OHCA has been recorded in electronic form completed by the emergency physician in charge of the patient and the dispatch center. During the study period, 23,772 cardiac arrests were reported in the RENAU registry, including 14% TCA.…”

Section: Data Collectionmentioning

confidence: 99%

“…In profound hypovolemia, chest compressions are likely to be ineffective due to poor cardiac lling (20) but it is currently recommended (21,22). A study on dogs have demonstrated that chest compressions do not improve survival in hypovolemic cardiac arrest (23). Moreover, immediate diagnosis of severe hypovolemia may be di cult in prehospital setting.…”

Section: Hypovolemiamentioning

confidence: 99%

Impact of specific emergency measures on survival of out of hospital traumatic cardiac arrest: data from the northern french alps cardiac arrest registry.

Savary¹,

Morin²,

Douillet³

et al. 2020

Preprint

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The management of Out of hospital Traumatic Cardiac Arrest (TCA) for professional rescuers combines advanced life support with specifics actions to treat potential reversible causes of the arrest: hypovolemia, hypoxemia, Tension Pneumothorax (TPx) and tamponade. The aim of this study was to assess the impact of specific rescue gestures on short-term outcomes in the context of resuscitation of patients with a pre-hospital TCA.Methods: We conducted a retrospective study of all TCA treated in two emergency medical units (EM unit), which are part of the Northern Alps emergency network, from January 2004 to December 2017. Utstein variables and specific rescue actions in TCA were compiled: advanced airway management, fluid administration, pelvic stabilization or tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary end point was the survival rate at day 30 with good neurologic outcome (cerebral performance category [CPC] score 1 & 2).Results: 287 resuscitations attempt in TCA were included and 279 specific interventions were Identified: 262 Fluid expansion, 41 External Pelvic stabilizations, 5 tourniquets, 175 bilateral thoracostomies, (including 44 with TPx).Conclusion: Among standard resuscitation measures to treat reversible causes of cardiac arrest, we were able to show that bilateral thoracostomy and tourniquet application on a limb hemorrhage improves survival of TCA. A larger sample for pelvic stabilization is necessary.

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Use of CPR in hemorrhagic shock, a dog model

Abstract: There was no benefit to chest compressions in the hypovolemic animals. Chest compressions in addition to fluid did not reverse signs of shock better than fluid alone. Further research is needed to define if there is a role of CPR in the trauma patient with hemorrhagic shock.

Cited by 19 publications

References 15 publications

Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest

Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest

Volume Resuscitation in the Acutely Hemorrhaging Patient: Historic Use to Current Applications

Impact of specific emergency measures on survival of out of hospital traumatic cardiac arrest: data from the northern french alps cardiac arrest registry.

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