Early volume expansion during cardiopulmonary resuscitation

Stephen J. Jameson, James R. Mateer, Daniel J DeBehnke

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective: To determine if hemodynamic parameters, return of spontaneous circulation (ROSC), and short term survival are improved by volume expansion during resuscitation from ventricular fibrillation cardiac arrest. Design: Randomized protocol. Setting: Animal research laboratory. Participants: 18 conventional swine. Interventions: Ventricular fibrillation was electrically induced after instrumentation. All swine fibrillated without intervention for 5 min and received 13 min of mechanical high-impulse (HICPR) prior to randomization. The resuscitation protocol included either epinephrine (0.014 mg/kg) alone (Group A) or epinephrine with a fluid bolus (4 cc/kg) of hypertonic saline-dextran (HSD) solution (Group B). Measurements and Main Results: Group A had 6 9 and Group B had 5 9 swine achieve ROSC and 2 9 vs. 4 9 swine survived 30 min, respectively (P = NS). Coronary perfusion pressures (CPP) measured during HICPR at 60, 90, and 120 s after infusion were not significantly different for the two groups. At 1 min after ROSC, CPP, aortic systolic blood pressure (AoSBP), and aortic diastolic pressure (AoDBP) were all significantly greater in Group B than in Group A (P < 0.05). Arterial and venous blood gases measured at 1 min after ROSC revealed a significantly lower pH and higher PCO2 in Group B animals. Conclusion: Early volume expansion with epinephrine during HICPR does not improve CPP, rate of ROSC, or rate of short term survival from VF arrest in this porcine model. HSD volume expansion does improve systemic hemodynamics after ROSC with increased CPP, AoDBP, and AoDBP. Improved tissue perfusion in Group B animals after ROSC is suggested by a decreased pH and increased Pco2 presumably secondary to enhanced mobilization of lactate and Pco2 from tissues.

Original languageEnglish (US)
Pages (from-to)243-250
Number of pages8
JournalResuscitation
Volume26
Issue number3
DOIs
StatePublished - Jan 1 1993

Fingerprint

Cardiopulmonary Resuscitation
Swine
Perfusion
Epinephrine
Ventricular Fibrillation
Pressure
Resuscitation
dextran - saline drug combination
Arterial Pressure
Hemodynamics
Blood Pressure
Coronary Circulation
Random Allocation
Heart Arrest
Lactic Acid
Gases

Keywords

  • Cardiopulmonary resuscitation
  • Heart arrest
  • Hypertonic saline solution

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Early volume expansion during cardiopulmonary resuscitation. / Jameson, Stephen J.; Mateer, James R.; DeBehnke, Daniel J.

In: Resuscitation, Vol. 26, No. 3, 01.01.1993, p. 243-250.

Research output: Contribution to journalArticle

Jameson, SJ, Mateer, JR & DeBehnke, DJ 1993, 'Early volume expansion during cardiopulmonary resuscitation', Resuscitation, vol. 26, no. 3, pp. 243-250. https://doi.org/10.1016/0300-9572(93)90145-G
Jameson, Stephen J. ; Mateer, James R. ; DeBehnke, Daniel J. / Early volume expansion during cardiopulmonary resuscitation. In: Resuscitation. 1993 ; Vol. 26, No. 3. pp. 243-250.
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AB - Objective: To determine if hemodynamic parameters, return of spontaneous circulation (ROSC), and short term survival are improved by volume expansion during resuscitation from ventricular fibrillation cardiac arrest. Design: Randomized protocol. Setting: Animal research laboratory. Participants: 18 conventional swine. Interventions: Ventricular fibrillation was electrically induced after instrumentation. All swine fibrillated without intervention for 5 min and received 13 min of mechanical high-impulse (HICPR) prior to randomization. The resuscitation protocol included either epinephrine (0.014 mg/kg) alone (Group A) or epinephrine with a fluid bolus (4 cc/kg) of hypertonic saline-dextran (HSD) solution (Group B). Measurements and Main Results: Group A had 6 9 and Group B had 5 9 swine achieve ROSC and 2 9 vs. 4 9 swine survived 30 min, respectively (P = NS). Coronary perfusion pressures (CPP) measured during HICPR at 60, 90, and 120 s after infusion were not significantly different for the two groups. At 1 min after ROSC, CPP, aortic systolic blood pressure (AoSBP), and aortic diastolic pressure (AoDBP) were all significantly greater in Group B than in Group A (P < 0.05). Arterial and venous blood gases measured at 1 min after ROSC revealed a significantly lower pH and higher PCO2 in Group B animals. Conclusion: Early volume expansion with epinephrine during HICPR does not improve CPP, rate of ROSC, or rate of short term survival from VF arrest in this porcine model. HSD volume expansion does improve systemic hemodynamics after ROSC with increased CPP, AoDBP, and AoDBP. Improved tissue perfusion in Group B animals after ROSC is suggested by a decreased pH and increased Pco2 presumably secondary to enhanced mobilization of lactate and Pco2 from tissues.

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