Abstract 17766: Active Intrathoracic Pressure Regulation Minimizes the Need for Vasopressors During Post Cardiac Arrest Care and Improves Cerebral Hemodynamics
Background: Post cardiac arrest care is a critical aspect of survival after cardiac arrest. Active intrathoracic pressure regulation (a-IPR) therapy consists of the delivery of a positive pressure ventilation followed by a sub-atmospheric expiratory phase pressure of -10 cmH2O. A-IPR has previously been shown to improve cerebral hemodynamics in subjects with brain injury and low perfusion states. This study tested the hypothesis that a-IPR applied during a six hour post-ROSC period would enhance cerebral hemodynamics and require less vasopressor support.
Methods: After 10 minutes of untreated ventricular fibrillation and six minutes of active compression decompression (ACD) CPR plus an impedance threshold device (ITD), 14 female pigs (39.1 ± 0.8 kg) were randomized into two post-ROSC treatment groups; one with continuous a-IPR therapy, the other without a-IPR therapy. A target mean arterial pressure (MAP) of 75 mmHg was achieved through controlled infusion of an epinephrine solution (0.002 mg/ml). MAP, vasopressor requirements and cerebral blood flow (CBF) were recorded continuously for six hours. Mann-Whitney tests were used for statistical comparisons. Data are expressed as mean ± SD.
Results: MAP throughout the study was matched between groups (76.6 ± 2.3 vs 75.2 ± 1.8 for a-IPR) through careful control of vasopressors. Total epinephrine during the post-ROSC period was reduced with a-IPR (0.16 ± 0.22 vs 0.44 ± 0.42 mg, p=0.05). Figure 1 shows the mean amount of epinephrine required in 30 minute intervals for the two groups. Mean CBF was significantly higher in the a-IPR group (23.4 ± 16.7 vs 37.0 ± 20.1 ml/100gm/min, p<0.0001).
Conclusions: Addition of a-IPR therapy during the post-ROSC period resulted in the need for less vasopressor support and improved cerebral hemodynamics. A-IPR has the potential to treat cardiovascular instability and brain injury; two major detriments to survival after cardiac arrest.
- Cardiopulmonary resuscitation
- Post cardiac arrest care
- Blood flow
- Return of spontaneous circulation (ROSC)
Author Disclosures: A. Metzger: Employment; Significant; employed by manufacturer of device utilized in study. M. Lick: None. P. Berger: Employment; Significant; employed by manufacturer of device utilized in study. N. Segal: None. A. Robinson: None. J. Moore: None. K. Lurie: Consultant/Advisory Board; Significant; consultant to manufacturer of device used in study.
- © 2016 by American Heart Association, Inc.