Demetris Yannopoulos1, Jason A Bartos2, Stephen A George2, George Sideris3, Sebastian Voicu3, Brett Oestreich2, Timothy Matsuura4, Kadambari Shekar4, Jennifer Rees2, Tom P Aufderheide5. 1. Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States. Electronic address: yanno001@umn.edu. 2. Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States. 3. Department of Cardiology, Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France. 4. Department of Integrated Biology & Physiology, University of Minnesota, Minneapolis, MN, United States. 5. Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
Abstract
INTRODUCTION: Sodium nitroprusside (SNP) enhanced CPR (SNPeCPR) demonstrates increased vital organ blood flow and survival in multiple porcine models. We developed a new, coronary occlusion/ischemia model of prolonged resuscitation, mimicking the majority of out-of-hospital cardiac arrests presenting with shockable rhythms. HYPOTHESIS: SNPeCPR will increase short term (4-h) survival compared to standard 2015 Advanced Cardiac Life Support (ACLS) guidelines in an ischemic refractory ventricular fibrillation (VF), prolonged CPR model. METHODS: Sixteen anesthetized pigs had the ostial left anterior descending artery occluded leading to ischemic VF arrest. VF was untreated for 5min. Basic life support was performed for 10min. At minute 10 (EMS arrival), animals received either SNPeCPR (n=8) or standard ACLS (n=8). Defibrillation (200J) occurred every 3min. CPR continued for a total of 45min, then the balloon was deflated simulating revascularization. CPR continued until return of spontaneous circulation (ROSC) or a total of 60min, if unsuccessful. SNPeCPR animals received 2mg of SNP at minute 10 followed by 1mg every 5min until ROSC. Standard ACLS animals received 0.5mg epinephrine every 5min until ROSC. Primary endpoints were ROSC and 4-h survival. RESULTS: All SNPeCPR animals (8/8) achieved sustained ROSC versus 2/8 standard ACLS animals within one hour of resuscitation (p=0.04). The 4-h survival was significantly improved with SNPeCPR compared to standard ACLS, 7/8 versus 1/8 respectively, p=0.0019. CONCLUSION: SNPeCPR significantly improved ROSC and 4-h survival compared with standard ACLS CPR in a porcine model of prolonged ischemic, refractory VF cardiac arrest.
INTRODUCTION:Sodium nitroprusside (SNP) enhanced CPR (SNPeCPR) demonstrates increased vital organ blood flow and survival in multiple porcine models. We developed a new, coronary occlusion/ischemia model of prolonged resuscitation, mimicking the majority of out-of-hospital cardiac arrests presenting with shockable rhythms. HYPOTHESIS: SNPeCPR will increase short term (4-h) survival compared to standard 2015 Advanced Cardiac Life Support (ACLS) guidelines in an ischemic refractory ventricular fibrillation (VF), prolonged CPR model. METHODS: Sixteen anesthetized pigs had the ostial left anterior descending artery occluded leading to ischemic VF arrest. VF was untreated for 5min. Basic life support was performed for 10min. At minute 10 (EMS arrival), animals received either SNPeCPR (n=8) or standard ACLS (n=8). Defibrillation (200J) occurred every 3min. CPR continued for a total of 45min, then the balloon was deflated simulating revascularization. CPR continued until return of spontaneous circulation (ROSC) or a total of 60min, if unsuccessful. SNPeCPR animals received 2mg of SNP at minute 10 followed by 1mg every 5min until ROSC. Standard ACLS animals received 0.5mg epinephrine every 5min until ROSC. Primary endpoints were ROSC and 4-h survival. RESULTS: All SNPeCPR animals (8/8) achieved sustained ROSC versus 2/8 standard ACLS animals within one hour of resuscitation (p=0.04). The 4-h survival was significantly improved with SNPeCPR compared to standard ACLS, 7/8 versus 1/8 respectively, p=0.0019. CONCLUSION:SNPeCPR significantly improved ROSC and 4-h survival compared with standard ACLS CPR in a porcine model of prolonged ischemic, refractory VF cardiac arrest.
Authors: Jason C Schultz; Nicolas Segal; Emily Caldwell; James Kolbeck; Scott McKnite; Nick Lebedoff; Menekhem Zviman; Tom P Aufderheide; Demetris Yannopoulos Journal: Crit Care Med Date: 2011-12 Impact factor: 7.598
Authors: Guillaume Debaty; Anja Metzger; Jennifer Rees; Scott McKnite; Laura Puertas; Demetris Yannopoulos; Keith Lurie Journal: Crit Care Med Date: 2015-05 Impact factor: 7.598
Authors: Jason Schultz; Nicolas Segal; James Kolbeck; Scott McKnite; Emily Caldwell; Demetris Yannopoulos Journal: Resuscitation Date: 2011-08-22 Impact factor: 5.262
Authors: Demetris Yannopoulos; Menekhem Zviman; Valeria Castro; Aravindan Kolandaivelu; Ravi Ranjan; Robert F Wilson; Henry R Halperin Journal: Circulation Date: 2009-09-21 Impact factor: 29.690
Authors: Tom P Aufderheide; Peter J Kudenchuk; Jerris R Hedges; Graham Nichol; Richard E Kerber; Paul Dorian; Daniel P Davis; Ahamed H Idris; Clifton W Callaway; Scott Emerson; Ian G Stiell; Thomas E Terndrup Journal: Resuscitation Date: 2008-05-19 Impact factor: 5.262
Authors: Demetris Yannopoulos; Jason A Bartos; Cindy Martin; Ganesh Raveendran; Emil Missov; Marc Conterato; R J Frascone; Alexander Trembley; Kevin Sipprell; Ranjit John; Stephen George; Kathleen Carlson; Melissa E Brunsvold; Santiago Garcia; Tom P Aufderheide Journal: J Am Heart Assoc Date: 2016-06-13 Impact factor: 5.501
Authors: Jason A Bartos; Timothy R Matsuura; Adamantios Tsangaris; Matthew Olson; Scott H McKnite; Jennifer N Rees; Karen Haman; Kadambari Chandra Shekar; Matthias L Riess; Frank S Bates; Joseph M Metzger; Demetris Yannopoulos Journal: JACC Basic Transl Sci Date: 2016-06
Authors: Susanne Rysz; Malin Jonsson Fagerlund; Johan Lundberg; Mattias Ringh; Jacob Hollenberg; Marcus Lindgren; Martin Jonsson; Therese Djärv; Per Nordberg Journal: J Clin Med Date: 2022-05-06 Impact factor: 4.964
Authors: Jason A Bartos; Sebastian Voicu; Timothy R Matsuura; Adamantios Tsangaris; Georgios Sideris; Brett A Oestreich; Stephen A George; Matthew Olson; Kadambari Chandra Shekar; Jennifer N Rees; Kathleen Carlson; Pierre Sebastian; Scott McKnite; Ganesh Raveendran; Tom P Aufderheide; Demetris Yannopoulos Journal: JACC Basic Transl Sci Date: 2017-06-21
Authors: Adrian Ripeckyj; Marinos Kosmopoulos; Kadambari Shekar; Claire Carlson; Rajat Kalra; Jennifer Rees; Tom P Aufderheide; Jason A Bartos; Demetris Yannopoulos Journal: JACC Basic Transl Sci Date: 2020-02-05
Authors: Christian Crouzet; Robert H Wilson; Donald Lee; Afsheen Bazrafkan; Bruce J Tromberg; Yama Akbari; Bernard Choi Journal: J Am Heart Assoc Date: 2020-01-04 Impact factor: 5.501
Authors: Pierre S Sebastian; Marinos N Kosmopoulos; Manan Gandhi; Alex Oshin; Matthew D Olson; Adrian Ripeckyj; Logan Bahmer; Jason A Bartos; Evangelos A Theodorou; Demetris Yannopoulos Journal: Resusc Plus Date: 2020-08-12