Abstract 19337: Preliminary Evaluation of a Pressor-Enhanced Approach to Robotic Signal-Guided Cardiopulmonary Resuscitation in a Swine Model of Ventricular Fibrillation
Introduction: Cardiopulmonary resuscitation (CPR) is largely a fixed process that does not adapt to the patient. Signal-guided (SG) CPR uses real-time signal analysis to optimize CPR and improve outcomes. The effects of pressors on SG-CPR are not fully known.
Hypothesis: We hypothesized that SG-CPR with SG-pressor administration would be feasible and would outperform standard CPR in a swine model of ventricular fibrillation (VF).
Methods: Mixed-breed (n = 19) swine were sedated, anesthetized, paralyzed, intubated and ventilated. Aortic and right atrial pressures were measured invasively. Coronary perfusion pressure was taken as the difference. Electrocardiogram (ECG) leads were placed for Leads I, II, and III, and the VF ECG median slope (MS) was calculated. VF was induced with a 3-second transthoracic shock and untreated for 8 minutes. Animals were randomized to SG-CPR or standard mechanical CPR (Std-CPR) with a custom SG-CPR device. Starting compression rate and depth were 100/minute and 2 inches, in 30:2 CPR configuration. In the SG-CPR group, the device incremented rate by 5 compressions/minute and depth by 0.2 inches per minute until a CPP threshold of 35mmHg or MS exceeded 75% its value at start of VF. In the Std-CPR group, epinephrine (0.015mg/kg) was administered at 2 minutes and repeated q3 minutes; in the SG-CPR group it was administered every 30 seconds until CPP exceeded 35mmHg. Defibrillation was attempted after 5 minutes of CPR, and CPR continued until return of spontaneous circulation (ROSC) or 20 minutes. Outcomes were time-to-peak CPP and MS, threshold passed, and ROSC. Continuous measures were compared with t-tests, dichotomous outcomes with Chi Squared tests.
Results: Mean (SD) time to peak CPP was 162s (87) Std-CPR and 57s (109) for SG-CPR (p=0.35). Time to peak MS was 194s (46) Std-CPR and 65s (114) for SG-CPR (p=0.88). Threshold achievement for CPP (p = 0.22) and MS (p = 0.22) was 50% and 38% for SG-CPR and 22% and 67% for Std-CPR. ROSC was 75% for SG-CPR and 44% for Std-CPR (p = 0.20).
Conclusions: SG-CPR with SG-epinephrine was feasible but did not outperform Std-CPR in hemodynamic, ECG or ROSC outcomes.
Author Disclosures: D.D. Salcido: Research Grant; Significant; Laerdal Foundation Grant, Henry L. Hillman Foundation, NHLBI K12 Career Development in Emergency Care Research. Other; Modest; Patent PCT/US2014/071544. M.L. Sundermann: Other; Modest; Patent PCT/US2014/071544. A.C. Koller: None. K.L. Flickinger: None. J.J. Menegazzi: Other; Modest; Patent PCT/US2014/071544.
- © 2016 by American Heart Association, Inc.