An experimental algorithm versus standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest

Menegazzi, James J.; Davis, Edward H.; Yealy, Donald M.; Molner, Renee; Nicklas, Kristine A; Hosack, Gina M; Honingford, Elizabeth A; Klain, Miroslav

doi:10.1016/s0196-0644(05)80211-2

Cited by 38 publications

(9 citation statements)

References 7 publications

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“…[1][2][3] Animal studies, in contrast, have demonstrated superior survival rates with drug use. [4][5][6][7][8][9][10][11][12][13] One reason for failure of animal studies to translate to clinical practice may be the time at which the first drug is delivered. Previous work has demonstrated the average time to first drug administration in clinical trials is 19.4 minutes (range 13.3-25.0; 95% CI around the mean 12.8, 25.9).…”

Section: Introductionmentioning

confidence: 99%

Drug administration in animal studies of cardiac arrest does not reflect human clinical experience

2007

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Introduction-To date, there is no evidence showing a benefit from any advanced cardiac life support (ACLS) medication in out-of-hospital cardiac arrest (OOHCA), despite animal data to the contrary. One explanation may be a difference in the time to first drug administration. Our previous work has shown the mean time to first drug administration in clinical trials is 19.4 minutes. We hypothesized that the average time to drug administration in large animal experiments occurs earlier than in OOHCA clinical trials.Methods-We conducted a literature review between 1990 and 2006 in MEDLINE using the following MeSH headings: swine, dogs, resuscitation, heart arrest, EMS, EMT, ambulance, ventricular fibrillation, drug therapy, epinephrine, vasopressin, amiodarone, lidocaine, magnesium, and sodium bicarbonate. We reviewed the abstracts of 331 studies and 197 full manuscripts. Exclusion criteria included: non-peer reviewed, all without primary animal data, and traumatic models. From these, we identified 119 papers that contained unique information on time to medication administration. The data are reported as mean, ranges, and 95% confidence intervals. Mean time to first drug administration in animal laboratory studies and clinical trials was compared with a t-test. Regression analysis was performed to determine if time to drug predicted ROSC.Results-Mean time to first drug administration in 2378 animals was 9.5 minutes (range 3.0-28.0; 95% CI around mean 2. 78, 16.22). This is less than the time reported in clinical trials (19.4 min, p<0.001). Time to drug predicted ROSC (Odds Ratio 0.844; 95% CI 0.738, 0.966).Conclusion-Shorter drug delivery time in animal models of cardiac arrest may be one reason for the failure of animal studies to translate successfully into the clinical arena.

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Section: Introductionmentioning

confidence: 99%

Drug administration in animal studies of cardiac arrest does not reflect human clinical experience

2007

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“…In other studies of prolonged VF, we achieved higher rates of ROSC and survival through the use of a drug cocktail that includes vasopressors during resuscitation. [9-15] Similar models used by Berg et al and Niemann et al also note higher rates of ROSC in a 7.5 to 8 minute VF cohort. [16, 17]…”

Section: Discussionmentioning

confidence: 76%

Increasing CPR duration prior to first defibrillation does not improve return of spontaneous circulation or survival in a swine model of prolonged ventricular fibrillation

et al. 2008

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Introduction-The optimum duration of cardiopulmonary resuscitation (CPR) prior to first rescue shock is unknown. Clinical trials have used 90s and 180s. Neither of these durations may be optimal. We sought to determine the optimum duration of CPR prior to first defibrillation attempt and whether this varied depending on the duration of ventricular fibrillation (VF). In this porcine model of basic life support, our outcomes were rates of return of spontaneous circulation (ROSC), survival, and coronary perfusion pressure (CPP).

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“…Several laboratory investigations suggest that beta-blockers given at the start of resuscitation efforts or after resuscitation from VF improve short term survival. (22)(23)(24)(25) However, these studies utilized cardiac electrical stimulation to induce VF in animals with normal coronary arteries and, with the exception of one study, betablockers were administered after restoration of circulation rather than before onset of arrest. It is uncertain if beta-blocker use prior to cardiac arrest will impact the effectiveness of currently recommended drugs, particularly if the beta-blocker is nonselective with an alpha-blockade effect.…”

Section: Discussionmentioning

confidence: 99%

56: Beta-Blocker Use and the Changing Epidemiology of Out-of-Hospital Cardiac Arrest Rhythms

Youngquist¹,

Kaji²,

Niemann³

2008

Annals of Emergency Medicine

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An experimental algorithm versus standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest

Cited by 38 publications

References 7 publications

Drug administration in animal studies of cardiac arrest does not reflect human clinical experience

Drug administration in animal studies of cardiac arrest does not reflect human clinical experience

Increasing CPR duration prior to first defibrillation does not improve return of spontaneous circulation or survival in a swine model of prolonged ventricular fibrillation

56: Beta-Blocker Use and the Changing Epidemiology of Out-of-Hospital Cardiac Arrest Rhythms

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