Abstract P151: A Randomized Comparison of Cardiocerebral and Cardiopulmonary Resuscitation Using a Swine Model of Prolonged Ventricular Fibrillation
Background: Cardiocerebral resuscitation (CCR) is reportedly superior to cardiopulmonary resuscitation (CPR) for OHCA. This new approach has its skeptics. This study was done to quantify the effect of the EMS component of CCR as compared to typical OHCA CPR using a swine model of prolonged untreated VF in a prospective randomized fashion.
Methods: The study was IACUC approved. All 53 animals were instrumented under anesthesia. VF was electrically induced. After 10″ of untreated VF, baseline characteristics were recorded, and animals were block randomized to 1 of 2 resuscitation schemes. The controls had mechanical chest compressions (MCC) at 100/minute with 30:2 ventilations. Consistent with clinical practice, 2 30-second pauses in MCC occurred to simulate attempts to accomplish endotracheal intubation (ETI) at minutes 1 and 3 of CPR and successful IV access was simulated to occur 3 additional minutes after ETI. The CCR group had continuous uninterrupted MCC at 100/minute. No active ventilations were provided. A tibial IO needle was placed in real-time for vascular access. Both groups received epinephrine (0.1mg/kg) as soon as access became available followed by 2.5″ of MCC before the first 120J rescue shock (RS) attempt. After successful RS, standardized post-resuscitative care was provided to a 20-minute endpoint. Failed RS was followed by continued MCC with positive pressure ventilation in both groups, repeat doses of epinephrine (0.01mg/kg) every 3 minutes, and RS every minute as long as a shockable rhythm persisted. Group comparisons were assessed using descriptive statistics. Proportions with 95% confidence intervals were calculated for VF termination, ROSC, and survival.
Results: At baseline, the two groups were the same. The table⇓ summarizes the outcomes.
Conclusion: In this swine model of witnessed VF arrest with no bystander-initiated resuscitation, CCR resulted in a substantial improvement in all 3 outcomes relative to typical OHCA EMS CPR.