Effects of ventricular fibrillation on coronary blood flow and myocardial metabolism

Grover, Frederick L.; Fewel, John G.; Ghidoni, John J.; Norton, J.B.; Trinkle, J. Kent

doi:10.1016/0002-9149(76)90607-x

Cited by 7 publications

(10 citation statements)

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“…2,29 We therefore implicate interruptions in chest compression, resulting in critical reductions in myocardial perfusion and with exacerbation of global ischemic injury of the heart, as explanations for the outcomes, especially in settings in which ventricular fibrillation consumes disproportionately large myocardial oxygen demands. 30,31 To this extent, the present studies only extend the well-established understanding that the longer the duration of myocardial ischemia, the greater is the impairment in myocardial function, whether it be a result of regional or global ischemia. [32][33][34] We recognize that the design and operation of current AEDs that mandate "hands-off" and therefore interruptions in precordial compression compromise outcomes.…”

Section: Discussionmentioning

confidence: 77%

Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation

et al. 2002

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Background-Current versions of automated external defibrillators (AEDs) require frequent stopping of chest compression for rhythm analyses and capacity charging. The present study was undertaken to evaluate the effects of these interruptions during the operation of AEDs. Methods and Results-Ventricular fibrillation was electrically induced in 20 male domestic swine weighing between 37. 5 and 43 kg that were untreated for 7 minutes before CPR was started. Defibrillation was attempted with up to 3 sequential 150-J biphasic shocks, but each was preceded by 3-, 10-, 15-, or 20-second interruptions of chest compression. The interruptions corresponded to those that were mandated by commercially marketed AEDs for rhythm analyses and capacitor charge. The sequence of up to 3 electrical shocks and delays were repeated at 1-minute intervals until the animals were successfully resuscitated or for a total of 15 minutes. Spontaneous circulation was restored in each of 5 animals in which precordial compression was delayed for 3 seconds before the delivery of the first and subsequent shocks but in none of the animals in which the delay was Ͼ15 seconds before the delivery of the first and subsequent shocks. Longer intervals of CPR interventions were required, and there was correspondingly greater failure of resuscitation in close relationship to increasing delays. The durations of interruptions were inversely related to the durations of subthreshold levels of coronary perfusion pressure. Postresuscitation arterial pressure and left ventricular ejection fraction were more severely impaired with increasing delays. Key Words: cardiopulmonary resuscitation Ⅲ fibrillation Ⅲ defibrillation Ⅲ compression Ⅲ myocardium A utomated external defibrillators (AEDs) provide the single best option for improving the currently poor outcomes of out-of-hospital cardiopulmonary resuscitation (CPR) performed by bystanders. Fundamental to the operation of AEDs is the capability of automated ECG rhythm analyses, during which CPR is interrupted. Previous experimental studies had demonstrated both decreased resuscitability and greater impairment of postresuscitation myocardial function and survival when precordial compression was interrupted for 20 seconds in small animals. 1-3 Because current versions of AEDs prompt "hands-off" intervals of Ͼ10 seconds for rhythm analyses before advising the rescuer to deliver an electrical shock, as documented below, we hypothesized that such interruptions would adversely affect the outcomes of CPR. Conclusions-InterruptionsThreshold levels of coronary perfusion pressure (CPP) are identified as major determinants of successful cardiac resuscitation. 4 -7 Interruptions in precordial compression predictably result in declines in CPP and therefore delays in restoring threshold values of CPP. 5,6 We therefore anticipated that increasing the length of intervals of interrupted chest compression results in corresponding decreases in the success of CPR and greater severity of postresuscitation myocardial dysfunction.These co...

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Section: Discussionmentioning

confidence: 77%

Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation

et al. 2002

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“…Mitral valve surgery under VF and intermittent ACC has been recognized a suboptimal strategy and was almost abandoned after the undesirable physiology of perfused VF and poor postoperative hemodynamic results were reported, [12][13][14] although these drawbacks could be reduced. 15,16 In the present study, the clinical results of both groups were comparable, although perfused VF was used in patients whose clinical condition was more complicated.…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Surgery Under Perfused Ventricular Fibrillation With Moderate Hypothermia.

Imanaka

Kyo

Ogiwara

et al. 2002

Circ J

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“…On the other hand, VF does not necessarily hamper the coronary flow mechanically as there is no synchronous contraction of the whole myocardium, but only of small bundles of muscle fibers, though at a high frequency. As concerns the findings of other authors, in dogs with cardiopulmonary bypass and extracorporeal circulation spontaneous VF led to a decrease (17), or an increase (6) in the subendocardial flow, or to no effect at all (1,4). Hottenrott et al (6,7,8) have pointed out that in hypertrophied hearts, however, VF leads to subendocardial ischemia, and that electrically maintained VF would do so also in normal, nonhypertrophied hearts.…”

Section: Discussionmentioning

confidence: 85%

“…Rather divergent results were obtained, however, as different kinds of artificial VF were used, namely permanently sustained fibrillation with electrical fibrillators, or VF was elicited electrically and allowed to persist spontaneously. Surprisingly, even after 60 min of VF no decrease of the myocardial ATP and creatine phosphate (CP) was detected (3,4). Moreover, after a period of 60 min (6,15,16) or even 8 h of spontaneous VF (14) cardiac function was not impaired.…”

Section: Introductionmentioning

confidence: 99%

Myocardial damage by ventricular fibrillation in isolated perfused rat hearts, and its underlying mechanisms

Heuer

Bernauer

1986

Basic Res Cardiol

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In isolated perfused rat hearts ventricular fibrillation (VF), elicited electrically and persisting further spontaneously, led to an extensive release of creatine kinase (CK). Coronary flow volume and oxygen consumption were increased. In contrast, the CK release was only very small in hearts which were stimulated permanently with rhythmic impulses of 10 Hz, whereas the increase in coronary flow and oxygen consumption was significantly greater. When a relative ischemia was induced by perfusion at a low pressure, the CK release from fibrillating hearts was not greater, but less than at a higher perfusion pressure. It appeared unlikely, therefore, that the CK release from fibrillating hearts was simply due to an oxygen deficiency, although a decrease of ATP and glycogen, and an increase of glucose-6-phosphate and lactate in the myocardium were found. When VF was interrupted by lidocaine, the enzyme leakage was reduced only in the experiments with the higher perfusion pressure. A partial restoration of the myocardial metabolites after 1 h was observed. Findings in maximally ischemic hearts further supported the idea that the enzyme release in fibrillating hearts was not merely due to a lack of oxygen. Complete interruption of the coronary perfusion led to the release of only small CK activities during subsequent coronary reperfusion, whereas the metabolic alterations were more distinct than in fibrillating hearts. Mechanisms responsible for the enzyme release during fibrillation, besides a moderate oxygen deficiency, are discussed.

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Effects of ventricular fibrillation on coronary blood flow and myocardial metabolism

Cited by 7 publications

References 0 publications

Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation

Adverse Outcomes of Interrupted Precordial Compression During Automated Defibrillation

Mitral Valve Surgery Under Perfused Ventricular Fibrillation With Moderate Hypothermia.

Myocardial damage by ventricular fibrillation in isolated perfused rat hearts, and its underlying mechanisms

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