Comparison of standard external CPR, open-chest CPR, and cardiopulmonary bypass in a canine myocardial infarct model

Daniel J. DeBehnke, Mark G. Angelos, James E. Leasure

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Study objectives: After cardiac arrest, open-chest CPR (OCCPR) and cardiopulmonary bypass (CPB) have demonstrated higher resuscitation rates when compared individually with standard external CPR (SECPR). We compared all three techniques in a canine myocardial infarct ventricular fibrillation model. Type of participants: Twenty-six mongrel dogs were block-randomized to receive SECPR and advanced life support (nine), CPB (nine), or OCCPR (eight). Design and interventions: All dogs received left anterior descending coronary artery occlusion followed by four minutes of ventricular fibrillation without CPR and eight minutes of Thumper® CPR. At 12 minutes, dogs received one of three resuscitation techniques. After resuscitation, all animals received four hours of intensive care. Animals that were resuscitated had histochemical determination of ischemic and necrotic myocardial areas. Measurements: Intravascular pressures were measured and coronary perfusion pressure was calculated during baseline, cardiac arrest, resuscitation, and postresuscitation periods. Percent necrotic myocardium, percent ischemic myocardium, and necrotic-to-ischemic ratios were determined for resuscitated animals. Epinephrine dosage and number of countershocks were determined for each group. Main results: Nine of nine CPB and six of nine OCCPR, compared with two of eight SECPR animals, were resuscitated (P < .01). Three of nine CPB and OCCPR and two of eight SECPR dogs survived to four hours (P = NS). Coronary perfusion pressure two minutes after institution of technique was significantly higher with CPB (75 ± 37 mm Hg) and OCCPR (56 ± 31 mm Hg) than in SECPR animals (16 ± 16 mm Hg, P < .04). Epinephrine required for resuscitation was significantly less with CPB (0.10 ± 0.02 mg/kg) than for SECPR (0.28 ± 0.11 mg/kg, P < .002). The ratio of necrotic to ischemic myocardium at four hours was significantly lower with CPB (0.15 ± 0.31) and OCCPR (0.39 ± 0.25) than for SECPR (1.16 ± 0.31, P < .02). Conclusion: OCCPR and CPB produce higher coronary perfusion pressures and improved resuscitation rates from ventricular fibrillation when compared with SECPR in this canine myocardial infarct cardiac arrest model. CPB and OCCPR yielded similar resuscitation results, although less epinephrine was required with CPB.

Original languageEnglish (US)
Pages (from-to)754-760
Number of pages7
JournalAnnals of emergency medicine
Volume20
Issue number7
DOIs
StatePublished - Jul 1991

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Cardiopulmonary Resuscitation
Cardiopulmonary Bypass
Canidae
Thorax
Myocardial Infarction
Resuscitation
Ventricular Fibrillation
Heart Arrest
Dogs
Epinephrine
Pressure
Myocardium
Perfusion
Coronary Occlusion
Critical Care

Keywords

  • CPR
  • cardiopulmonary bypass
  • myocardial infarction
  • ventricular fibrillation

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Comparison of standard external CPR, open-chest CPR, and cardiopulmonary bypass in a canine myocardial infarct model. / DeBehnke, Daniel J.; Angelos, Mark G.; Leasure, James E.

In: Annals of emergency medicine, Vol. 20, No. 7, 07.1991, p. 754-760.

Research output: Contribution to journalArticle

DeBehnke, Daniel J. ; Angelos, Mark G. ; Leasure, James E. / Comparison of standard external CPR, open-chest CPR, and cardiopulmonary bypass in a canine myocardial infarct model. In: Annals of emergency medicine. 1991 ; Vol. 20, No. 7. pp. 754-760.
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N2 - Study objectives: After cardiac arrest, open-chest CPR (OCCPR) and cardiopulmonary bypass (CPB) have demonstrated higher resuscitation rates when compared individually with standard external CPR (SECPR). We compared all three techniques in a canine myocardial infarct ventricular fibrillation model. Type of participants: Twenty-six mongrel dogs were block-randomized to receive SECPR and advanced life support (nine), CPB (nine), or OCCPR (eight). Design and interventions: All dogs received left anterior descending coronary artery occlusion followed by four minutes of ventricular fibrillation without CPR and eight minutes of Thumper® CPR. At 12 minutes, dogs received one of three resuscitation techniques. After resuscitation, all animals received four hours of intensive care. Animals that were resuscitated had histochemical determination of ischemic and necrotic myocardial areas. Measurements: Intravascular pressures were measured and coronary perfusion pressure was calculated during baseline, cardiac arrest, resuscitation, and postresuscitation periods. Percent necrotic myocardium, percent ischemic myocardium, and necrotic-to-ischemic ratios were determined for resuscitated animals. Epinephrine dosage and number of countershocks were determined for each group. Main results: Nine of nine CPB and six of nine OCCPR, compared with two of eight SECPR animals, were resuscitated (P < .01). Three of nine CPB and OCCPR and two of eight SECPR dogs survived to four hours (P = NS). Coronary perfusion pressure two minutes after institution of technique was significantly higher with CPB (75 ± 37 mm Hg) and OCCPR (56 ± 31 mm Hg) than in SECPR animals (16 ± 16 mm Hg, P < .04). Epinephrine required for resuscitation was significantly less with CPB (0.10 ± 0.02 mg/kg) than for SECPR (0.28 ± 0.11 mg/kg, P < .002). The ratio of necrotic to ischemic myocardium at four hours was significantly lower with CPB (0.15 ± 0.31) and OCCPR (0.39 ± 0.25) than for SECPR (1.16 ± 0.31, P < .02). Conclusion: OCCPR and CPB produce higher coronary perfusion pressures and improved resuscitation rates from ventricular fibrillation when compared with SECPR in this canine myocardial infarct cardiac arrest model. CPB and OCCPR yielded similar resuscitation results, although less epinephrine was required with CPB.

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