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Experimental paper| Volume 85, ISSUE 12, P1704-1707, December 2014

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Hemodynamic improvement of a LUCAS 2 automated device by addition of an impedance threshold device in a pig model of cardiac arrest

Published:September 25, 2014DOI:https://doi.org/10.1016/j.resuscitation.2014.09.013
Hemodynamic improvement of a LUCAS 2 automated device by addition of an impedance threshold device in a pig model of cardiac arrest
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      Abstract

      Introduction

      The combination of the LUCAS 2 (L-CPR) automated CPR device and an impedance threshold device (ITD) has been widely implemented in the clinical field. This animal study tested the hypothesis that the addition of an ITD on L-CPR would enhance cerebral and coronary perfusion pressures.

      Methods

      Ten female pigs (39.0 ± 2.0 kg) were sedated, intubated, anesthetized with isofluorane, and paralyzed with succinylcholine (93.3 μg/kg/min) to inhibit the potential confounding effect of gasping. After 4 min of untreated ventricular fibrillation, 4 min of L-CPR + an active ITD or L-CPR + a sham ITD was initiated and followed by another 4 min of the alternative method of CPR. Systolic blood pressure (SBP), diastolic blood pressure (DBP), diastolic right atrial pressure (RAP), intracranial pressure (ICP), airway pressure, and end tidal CO2 (ETCO2) were recorded continuously. Data expressed as mean mmHg ± SD.

      Results

      Decompression phase airway pressure was significantly lower with L-CPR + active ITD versus L-CPR + sham ITD (−5.3 ± 2.2 vs. −0.5 ± 0.6; p < 0.001). L-CPR + active ITD treatment resulted in significantly improved hemodynamics versus L-CPR + sham ITD: ETCO2, 35 ± 6 vs. 29 ± 7 (p = 0.015); SBP, 99 ± 9 vs. 93 ± 15 (p = 0.050); DBP, 24 ± 12 vs. 19 ± 15 (p = 0.006); coronary perfusion pressure, 29 ± 8 vs. 26 ± 7 (p = 0.004) and cerebral perfusion pressure, 24 ± 13 vs. 21 ± 12 (p = 0.028).

      Conclusions

      In pigs undergoing L-CPR the addition of the active ITD significantly reduced intrathoracic pressure and increased vital organ perfusion pressures.

      Keywords

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      References

        • Meaney P.A.
        • Bobrow B.J.
        • Mancini M.E.
        • et al.
        Cardiopulmonary resuscitation quality: improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association.
        Circulation. 2013; 128: 417-435
        View in Article
        • Cohen T.J.
        • Tucker K.J.
        • Lurie K.G.
        • et al.
        Active compression–decompression. A new method of cardiopulmonary resuscitation, Cardiopulmonary Resuscitation Working Group.
        J Am Med Assoc. 1992; 267: 2916-2923
        View in Article
        • Duggal C.
        • Weil M.H.
        • Gazmuri R.J.
        • et al.
        Regional blood flow during closed-chest cardiac resuscitation in rats.
        J Appl Physiol. 1993; 74: 147-152
        View in Article
        • Steen S.
        • Liao Q.
        • Pierre L.
        • Paskevicius A.
        • Sjoberg T.
        Evaluation of LUCAS, a new device for automatic mechanical compression and active decompression resuscitation.
        Resuscitation. 2002; 55: 285-299
        View in Article
        • Rubertsson S.
        • Karlsten R.
        Increased cortical cerebral blood flow with LUCAS: a new device for mechanical chest compressions compared to standard external compressions during experimental cardiopulmonary resuscitation.
        Resuscitation. 2005; 65: 357-363
        View in Article
        • Axelsson C.
        • Karlsson T.
        • Axelsson A.B.
        • Herlitz J.
        Mechanical active compression–decompression cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end tidal carbon dioxide (P(ET)CO2) during CPR in out-of-hospital cardiac arrest (OHCA).
        Resuscitation. 2009; 80: 1099-1103
        View in Article
        • Lurie K.G.
        • Coffeen P.
        • Shultz J.
        • McKnite S.
        • Detloff B.
        • Mulligan K.
        Improving active compression–decompression cardiopulmonary resuscitation with an inspiratory impedance valve.
        Circulation. 1995; 91: 1629-1632
        View in Article
        • Lurie K.G.
        • Zielinski T.
        • McKnite S.
        • Aufderheide T.
        • Voelckel W.
        Use of an inspiratory impedance valve improves neurologically intact survival in a porcine model of ventricular fibrillation.
        Circulation. 2002; 105: 124-129
        View in Article
        • Lurie K.G.
        • Yannopoulos D.
        • McKnite S.H.
        • et al.
        Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest.
        Respir Care. 2008; 53: 862-870
        View in Article
        • Lurie K.G.
        • Mulligan K.A.
        • McKnite S.
        • Detloff B.
        • Lindstrom P.
        • Lindner K.H.
        Optimizing standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve.
        Chest. 1998; 113: 1084-1090
        View in Article
        • Lurie K.G.
        • Voelckel W.G.
        • Zielinski T.
        • et al.
        Improving standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve in a porcine model of cardiac arrest.
        Anesth Analg. 2001; 93: 649-655
        View in Article
        • Pirrallo R.G.
        • Aufderheide T.P.
        • Provo T.A.
        • Lurie K.G.
        Effect of an inspiratory impedance threshold device on hemodynamics during conventional manual cardiopulmonary resuscitation.
        Resuscitation. 2005; 66: 13-20
        View in Article
        • Stiell I.G.
        • Brown S.P.
        • Christenson J.
        • et al.
        What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation.
        Crit Care Med. 2012; 40: 1192-1198
        View in Article
        • Abella B.S.
        • Sandbo N.
        • Vassilatos P.
        • et al.
        Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest.
        Circulation. 2005; 111: 428-434
        View in Article
        • Idris A.H.
        • Guffey D.
        • Pepe P.E.
        • et al.
        The interaction of chest compression rates with the impedance threshold device and association with survival following out-of-hospital cardiac arrest – abstract late breaking clinical trial.
        Circulation. 2012; 126: 2776-2799
        View in Article

      Article info

      Publication history

      Published online: September 25, 2014
      Accepted: September 8, 2014
      Received in revised form: August 23, 2014
      Received: July 7, 2014

      Footnotes

      ☆A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.09.013.

      Identification

      DOI: https://doi.org/10.1016/j.resuscitation.2014.09.013

      Copyright

      © 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.

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