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PRECLINICAL STUDY

Rapid Induction of Cerebral Hypothermia Is Enhanced With Active Compression-Decompression Plus Inspiratory Impedance Threshold Device Cardiopulmonary Resusitation in a Porcine Model of Cardiac Arrest

Vijay Srinivasan, MD^_*, Vinay M. Nadkarni, MD, MS^_*,_*, Demetris Yannopoulos, MD, Bradley S. Marino, MD, MSCE, MPP^_*, Gardar Sigurdsson, MD, Scott H. McKnite, BS, Maureen Zook, BA, David G. Benditt, MD^,1 and Keith G. Lurie, MD^,2

^_* Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Hennepin County Medical Center and the Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota

Manuscript received June 2, 2005; revised manuscript received September 8, 2005, accepted September 19, 2005.

^_* Reprint requests and correspondence: Dr. Vinay M. Nadkarni, Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, Pennsylvania 19104. (Email: Nadkarni{at}email.chop.edu).

OBJECTIVES: A rapid, ice-cold saline flush combined with active compression-decompression (ACD) plus an inspiratory impedance threshold device (ITD) cardiopulmonary resusitation (CPR) will cool brain tissue more effectively than with standard CPR (S-CPR) during cardiac arrest (CA).

BACKGROUND: Early institution of hypothermia after CPR and return of spontaneous circulation improves survival and outcomes after CA in humans.

METHODS: Ventricular fibrillation (VF) was induced for 8 min in anesthetized and tracheally intubated pigs. Pigs were randomized to receive either ACD + ITD CPR (n = 8) or S-CPR (n = 8). After 2 min of CPR, 30 ml/kg ice-cold saline (3°C) was infused over the next 3 min of CPR via femoral vein followed by up to three defibrillation attempts (150 J, biphasic). If VF persisted, epinephrine (40 µg/kg) and vasopressin (0.3 U/kg) were administered followed by three additional defibrillation attempts. Hemodynamic variables and temperatures were continuously recorded.

RESULTS: All ACD + ITD CPR pigs (8 of 8) survived (defined as 15 min of return of spontaneous circulation [ROSC]) versus 3 of 8 pigs with S-CPR (p < 0.05). In survivors, brain temperature (°C) measured at 2-cm depth in brain cortex 1 min after ROSC decreased from 37.6 ± 0.2 to 35.8 ± 0.3 in ACD + ITD CPR versus 37.8 ± 0.2 to 37.3 ± 0.3 in S-CPR (p < 0.005). Immediately before defibrillation: 1) right atrial systolic/diastolic pressures (mm Hg) were lower (85 ± 19, 4 ± 1) in ACD + ITD CPR than S-CPR pigs (141 ± 12, 8 ± 3, p < 0.01); and 2) coronary perfusion pressures (mm Hg) were higher in ACD + ITD CPR (28.3 ± 2) than S-CPR pigs (17.4 ± 3, p < 0.01).

CONCLUSIONS: A rapid ice-cold saline infusion combined with ACD + ITD CPR during cardiac arrest induces cerebral hypothermia more rapidly immediately after ROSC than with S-CPR.

Abbreviations and Acronyms   ACD = active compression-decompression   AHA = American Heart Association   CA = cardiac arrest   CPR = cardiopulmonary resuscitation   ITD = impedance threshold device   IV = intravenous   ROSC = return of spontaneous circulation   S-CPR = standard cardiopulmonary resuscitation   VF = ventricular fibrillation

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