Abstract 89: Enhanced Perfusion During Advanced Life Support Improves Survival with Favorable Neurological Function in a Porcine Model of Refractory Cardiac Arrest
Introduction: Despite both Basic Life Support (BLS) and Advanced Life Support (ALS) most cardiac arrest patients die. To improve the likelihood for survival with favorable neurological function, we assessed a new ALS approach using the combination of active compression decompression (ACD) cardio-pulmonary resuscitation (CPR) plus an intrathoracic pressure regulator (ACD-ITPR). Recent CPR studies have shown that ACD-ITPR provides greater blood flow to the heart and brain than standard CPR or ACD CPR plus an impedance threshold device (ITD).
Method: Ventricular fibrillation (VF) was induced in 18 female farm pigs (39±3 Kg) anesthetized with 1.5% isoflurane. Twelve minutes later they were randomized to 3 groups (n=6/group): Group A - 3 minutes of BLS with S-CPR, 3 defibrillation shocks, and 2 minutes of ALS with S-CPR then 3 shocks; Group B - 3 minutes of BLS with S-CPR, 3 shocks, and 2 minutes of ALS with ACD-IPR then 3 shocks; and Group C - 3 minute of BLS with ACD CPR +ITD, 3 shocks, and 2 minutes of ALS with ACD-ITPR. ALS always included intravenous epinephrine (0.05mcg/kg). The primary endpoint was 24-hour Cerebral Performance Category (CPC) score determined by a veterinarian blinded to the CPR method. Hemodynamic parameters and left ventricular function were also measured. Fisher’s exact and Kruskal-Wallis tests were used for statistical analyses.
Results: Six pigs survived for 24 hours in Groups B and C versus 1/6 in Group A (p=0.002). CPC scores were 4.7±0.8, 1.7±0.8 and 1.0±0 for Groups A, B, and C, respectively (p=0.001).
Conclusion: ALS with ACD-ITPR significantly improved 24 survival rates with favorable neurological function in a porcine model of prolonged cardiac arrest.
Author Disclosures: G. Debaty: None. A. Metzger: Employment; Significant; Advanced Circulatory Systems, Inc. J. Rees: Employment; Significant; Advanced Circulatory Systems, Inc.. S. McKnite: None. L. Puertas: Employment; Significant; Advanced Circulatory Systems, Inc. D. Yannopoulos: Research Grant; Significant; NIH 1R01HL123227-02; R01HL108926-04. K.G. Lurie: Employment; Significant; Advanced Circulatory Systems, Inc.. Ownership Interest; Significant; Advanced Circulatory Systems, Inc..
- © 2014 by American Heart Association, Inc.