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.
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http://dx.doi.org/10.1016/j.resuscitation.2016.05.008 | DOI Listing |
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Department of Neurology, Peking University First Hospital, Beijing, China. Electronic address:
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Department of Pharmacology, Key Laboratory of Anti-Inflammatory and Immunopharmacology of Ministry of Education, Key Laboratory of Chinese Medicine Research and Development of State Administration of Traditional Chinese Medicine, Anhui Medical University, Hefei, Anhui, People's Republic of China. Electronic address:
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State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, 611137 , P.R. China; College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, P.R. China. Electronic address:
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Chongqing Key Laboratory of Reproductive Health and Digital Medicine, Department of Laboratory Medicine, Chongqing General Hospital, School of Medicine, Chongqing University, Chongqing, 400044, People's Republic of China; College of Life Science and Laboratory Medicine, Kunming Medical University, Kunming, Yunnan, 650050, People's Republic of China. Electronic address:
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