Resuscitation After Prolonged Cardiac Arrest: Role of Cardiopulmonary Bypass and Systemic Hyperkalemia

Abstract

Background. The purpose of this study was to determine (1) the role of emergency cardiopulmonary bypass (CPB) after prolonged cardiac arrest and failed cardiopulmonary resuscitation, and (2) the use of systemic hyperkalemia during CPB to convert intractable ventricular fibrillation (VF).Methods. Thirty-one pigs (34 ؎ 2 kg) underwent 15 minutes of cardiac arrest after induced VF, followed by 10 minutes of cardiopulmonary resuscitation-advanced life support. Peripheral CPB was used if cardiopulmonary resuscitation failed to restore stable circulation. Damage was assessed by evaluating hemodynamics, biochemical variables (creatine kinase-MB, neuron-specific enolase), neurologic deficit score, and brain magnetic resonance imaging.Results. Cardiopulmonary resuscitation alone was successful in only 19% (6 of 31 pigs). Cardiopulmonary bypass was initiated in 81% of animals (25 of 31 pigs) either for hypotension (5 of 25 pigs) or intractable VF (20 of 25 pigs). Defibrillation was successful in 7 of 20 animals during the first 10 minutes after initiating CPB.

Resuscitation after prolonged cardiac arrest: effects of cardiopulmonary bypass and sodium–hydrogen exchange inhibition on myocardial and neurological recovery☆

“…The experimental protocol used in this study has been described in detail previously [6], and is, therefore, briefly summarized.…”

“…Normothermic, full-flow CPB (100-150 ml kg À1 min À1 ) was initiated, if the 10-min CPR-ALS interval did not successfully restore stable spontaneous circulatory function (ROSC), defined as either persistence of ventricular fibrillation or return of supraventricular rhythm, but inability to maintain a mean arterial pressure >50 mmHg for 1 min [6].…”

“…CPB management and post-resuscitation care of subjects was facilitated, as previously reported [6]. After successful cardioversion of VF on CPB following repeated countershocks, discontinuation of CPB was initiated when spontaneous hemodynamic performance maintained mean arterial pressure >50 mmHg with or without dopamine (5-10 mg kg À1 min À1 ) or norepinephrine (0.01-0.15 mg kg À1 min À1 ) support.…”

“…Compared with CPR-advanced life support (CPR-ALS), CPB facilitates stable restoration of cerebral and cardiac blood flow, and may allow recovery of the stunned myocardium even after prolonged ischemic periods [3][4][5]. We have recently reported a 64% 24-h survival using normothermic CPB after 15 min of prolonged CA that was unresponsive to CPR-ALS in pigs [6]. However, despite improved survival with CPB, hypoxic brain injury was present in all animals, and was coupled to severe neurological impairment.…”

β-receptor blocker influences return of spontaneous circulation and chemical examination in rats during cardiopulmonary resuscitation

“…However, Lisachenko and Ivanova (1999) performed experiments on 25 dogs, and showed that the blood K + value decreased in the prophase (5 min to 9 h). Although high blood K + was thought to be associated with the development of pulseless electrical activity (Tran, 2005), high K + injection could end ventricular fibrillation, resulting in a higher ROSC rate (Liakopoulos et al, 2010). Elevated blood K + during CPR may be attributed to the accumulation of K + from intracellular and damaged cells of the pressed tissue, and has nothing to do with the amount of epinephrine (Lindner et al, 1988).…”