The Influence of Ultra-Low Tidal Volume Ventilation during Cardiopulmonary Resuscitation on Renal and Hepatic End-Organ Damage in a Porcine Model

Abstract

The optimal ventilation strategy during cardiopulmonary resuscitation (CPR) has eluded scientists for years. This porcine study aims to validate the hypothesis that ultra-low tidal volume ventilation (tidal volume 2–3 mL kg−1; ULTVV) minimizes renal and hepatic end-organ damage when compared to standard intermittent positive pressure ventilation (tidal volume 8–10 mL kg−1; IPPV) during CPR. After induced ventricular fibrillation, the animals were ventilated using an established CPR protocol. Upon return of spontaneous circulation (ROSC), the follow-up was 20 h. After sacrifice, kidney and liver samples were harvested and analyzed histopathologically using an Endothelial, Glomerular, Tubular, and Interstitial (EGTI) scoring system for the kidney and a newly developed scoring system for the liver. Of 69 animals, 5 in the IPPV group and 6 in the ULTVV group achieved sustained ROSC and were enlisted, while 4 served as the sham group. Creatinine clearance was significantly lower in the IPPV-group than in the sham group (p < 0.001). The total EGTI score was significantly higher for ULTVV than for the sham group (p = 0.038). Aminotransferase levels and liver score showed no significant difference between the intervention groups. ULTVV may be advantageous when compared to standard ventilation during CPR in the short-term ROSC follow-up period.

Ultra-low tidal volume ventilation during cardiopulmonary resuscitation shows no mitigating effect on pulmonary end-organ damage compared to standard ventilation: insights from a porcine model

“…Ruemmler et al [3] were able to demonstrate in a pilot study in a porcine model that this ventilation mode, which is already well-established in acute respiratory distress syndrome (ARDS) studies [4][5][6], showed advantages in terms of brain end-organ damage and did not exhibit any disadvantages regarding oxygenation during resuscitation and up to 6 h thereafter. Similarly, another animal study by this research group showed a reduced creatinine clearance during the short-term period after return of spontaneous circulation (ROSC) applying IPPV [7], suggesting potential end-organ damage mitigation by applying ULTVV. From a physiological point of view, the use of lower tidal volumes during mechanical ventilation is associated with a decrease in intrathoracic pressure [8].…”