Guillaume Debaty1, Keith Lurie2, Anja Metzger2, Michael Lick2, Jason A Bartos3, Jennifer N Rees3, Scott McKnite3, Laura Puertas2, Paul Pepe4, Raymond Fowler4, Demetris Yannopoulos3. 1. Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA; University Grenoble Alps/CNRS/CHU de Grenoble/TIMC-IMAG UMR 5525, Grenoble, France. Electronic address: gdebaty@gmail.com. 2. Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA. 3. Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA. 4. University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8579, USA.
Abstract
OBJECTIVE: Ischemic postconditioning (PC) using three intentional pauses at the start of cardiopulmonary resuscitation (CPR) improves outcomes after cardiac arrest in pigs when epinephrine (epi) is used before defibrillation. We hypothesized PC, performed during basic life support (BLS) in the absence of epinephrine, would reduce reperfusion injury and enhance 24h functional recovery. DESIGN: Prospective animal investigation. SETTING: Animal laboratory SUBJECTS: Female farm pigs (n=46, 39±1kg). INTERVENTIONS: Protocol A: After 12min of ventricular fibrillation (VF), 28 pigs were randomized to four groups: (A) Standard CPR (SCPR), (B) active compression-decompression CPR with an impedance threshold device (ACD-ITD), (C) SCPR+PC (SCPR+PC) and (D) ACD-ITD CPR+PC. Protocol B: After 15min of VF, 18 pigs were randomized to ACD-ITD CPR or ACD-ITD+PC. The BLS duration was 2.75min in Protocol A and 5min in Protocol B. Following BLS, up to three shocks were delivered. Without return of spontaneous circulation (ROSC), CPR was resumed and epi (0.5mg) and defibrillation delivered. The primary end point was survival without major adverse events. Hemodynamic parameters and left ventricular ejection fraction (LVEF) were also measured. Data are presented as mean±SEM. MEASUREMENTS AND MAIN RESULTS: Protocol A: ACD-ITD+PC (group D) improved coronary perfusion pressure after 3min of BLS versus the three other groups (28±6, 35±7, 23±5 and 47±7 for groups A, B, C, D respectively, p=0.05). There were no significant differences in 24h survival between groups. PROTOCOL B: LVEF 4h post ROSC was significantly higher with ACD-ITD+PC vs ACD-ITD alone (52.5±3% vs. 37.5±6.6%, p=0.045). Survival rates were significantly higher with ACD-ITD+PC vs. ACD-ITD alone (p=0.027). CONCLUSIONS: BLS using ACD-ITD+PC reduced post resuscitation cardiac dysfunction and improved functional recovery after prolonged untreated VF in pigs. PROTOCOL NUMBER: 12-11.
OBJECTIVE: Ischemic postconditioning (PC) using three intentional pauses at the start of cardiopulmonary resuscitation (CPR) improves outcomes after cardiac arrest in pigs when epinephrine (epi) is used before defibrillation. We hypothesized PC, performed during basic life support (BLS) in the absence of epinephrine, would reduce reperfusion injury and enhance 24h functional recovery. DESIGN: Prospective animal investigation. SETTING: Animal laboratory SUBJECTS: Female farm pigs (n=46, 39±1kg). INTERVENTIONS: Protocol A: After 12min of ventricular fibrillation (VF), 28 pigs were randomized to four groups: (A) Standard CPR (SCPR), (B) active compression-decompression CPR with an impedance threshold device (ACD-ITD), (C) SCPR+PC (SCPR+PC) and (D) ACD-ITDCPR+PC. Protocol B: After 15min of VF, 18 pigs were randomized to ACD-ITDCPR or ACD-ITD+PC. The BLS duration was 2.75min in Protocol A and 5min in Protocol B. Following BLS, up to three shocks were delivered. Without return of spontaneous circulation (ROSC), CPR was resumed and epi (0.5mg) and defibrillation delivered. The primary end point was survival without major adverse events. Hemodynamic parameters and left ventricular ejection fraction (LVEF) were also measured. Data are presented as mean±SEM. MEASUREMENTS AND MAIN RESULTS: Protocol A: ACD-ITD+PC (group D) improved coronary perfusion pressure after 3min of BLS versus the three other groups (28±6, 35±7, 23±5 and 47±7 for groups A, B, C, D respectively, p=0.05). There were no significant differences in 24h survival between groups. PROTOCOL B: LVEF 4h post ROSC was significantly higher with ACD-ITD+PC vs ACD-ITD alone (52.5±3% vs. 37.5±6.6%, p=0.045). Survival rates were significantly higher with ACD-ITD+PC vs. ACD-ITD alone (p=0.027). CONCLUSIONS: BLS using ACD-ITD+PC reduced post resuscitation cardiac dysfunction and improved functional recovery after prolonged untreated VF in pigs. PROTOCOL NUMBER: 12-11.
Authors: Joseph Varney; Karam R Motawea; Mostafa R Mostafa; Yossef H AbdelQadir; Merna Aboelenein; Omneya A Kandil; Nancy Ibrahim; Hashim T Hashim; Kimberly Murry; Garrett Jackson; Jaffer Shah; Maty Boury; Ahmed K Awad; Priya Patel; Dina M Awad; Samah S Rozan; Nesreen E Talat Journal: Health Sci Rep Date: 2022-05-24
Authors: Johanna C Moore; Bayert Salverda; Michael Lick; Carolina Rojas-Salvador; Nicolas Segal; Guillaume Debaty; Keith G Lurie Journal: Resuscitation Date: 2020-02-27 Impact factor: 5.262
Authors: Ying Kiat Tan; Ming Xuan Han; Benjamin Yong-Qiang Tan; Ching-Hui Sia; Claire Xin Yi Goh; Aloysius Sheng-Ting Leow; Derek J Hausenloy; Edwin Shih Yen Chan; Marcus Eng Hock Ong; Andrew Fu Wah Ho Journal: Ann Transl Med Date: 2022-05