Abstract 18285: Sodium Nitroprusside Enhanced Cardiopulmonary Resuscitation Improves Short Term Survival in a Porcine Model of Ischemic Refractory Ventricular Fibrillation
Introduction: Sodium nitroprusside (SNP) enhanced CPR (SNPeCPR) has demonstrated increased vital organ blood flow and survival in multiple porcine models. Since the majority of out of hospital cardiac arrests presenting with shockable rhythms have coronary ischemia, we developed a coronary occlusion/ischemia model of prolonged resuscitation to simulate refractory VF patients.
Hypothesis: We hypothesized that SNPeCPR will increase short term (4-hour) survival compared to standard 2015 AHA ACLS guidelines in an ostial left anterior descending (LAD) coronary artery occlusion refractory VF, prolonged (40 minutes) CPR model.
Methods: Fifteen female, intubated and isoflurane anesthetized pigs, had the ostial LAD occluded with a 4.0x15 mm coronary balloon. Induced ischemic VF was untreated for 5 minutes. BLS was then performed for 10 minutes and defibrillation shocks (200J) were delivered every 3 minutes. At minute 10 (EMS arrival), animals were randomized to receive either SNPeCPR (n=8 pigs) or standard ACLS (n=7). CPR continued for a total of 40 minutes (simulating arrival to the cardiac catheterization laboratory). At that point, with ongoing CPR, the balloon was deflated to simulate revascularization. CPR was continued until return of spontaneous circulation (ROSC) was achieved or for a total of 60 minutes, if unsuccessful. SNPeCPR animals received a first dose of 2mg of SNP at minute 10, followed by 1mg every 5 minutes until ROSC. Standard ACLS animals received 0.5mg epinephrine every 5 minutes starting at minute 10 until ROSC or end of protocol. Primary endpoints were ROSC and 4-hour survival.
Results: All SNPeCPR animals (8/8) achieved ROSC versus 5/7 standard ACLS animals (p=0.20). Seven of eight animals in the SNPeCPR group survived to 4 hours versus 2/7 in the standard ACLS group (p=0.04). SNPeCPR animals had similar coronary perfusion pressure but significantly lower peak lactic acid levels during CPR (8.6±3.2 versus 12.8±3.3 p=0.026) compared to standard ACLS animals.
Conclusions: SNPeCPR resulted in significantly improved 4-hour survival compared with standard ACLS CPR in a porcine model of ischemic, refractory VF cardiac arrest. SNPeCPR animals maintained improved end organ perfusion as measured by serum lactate.
Author Disclosures: S.A. George: None. J.A. Bartos: None. T. Matsuura: None. J. Rees: None. M. Olson: None. S. McKnite: None. K. Shekar: None. T.P. Aufderheide: None. D. Yannopoulos: None.
- © 2016 by American Heart Association, Inc.