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Comparison of standard external CPR, open-chest CPR, and cardiopulmonary bypass in a canine myocardial infarct model
D J DeBehnke1, M G Angelos, J E Leasure
1Department of Emergency Medicine, Wright State University School of Medicine, Dayton, Ohio.
Insights
Open-chest CPR (OCCPR) and cardiopulmonary bypass (CPB) significantly improve resuscitation rates and coronary perfusion pressure following cardiac arrest compared to standard external CPR (SECPR). These advanced methods reduce myocardial damage in a canine model.
Area of Science:
- Cardiovascular Research
- Emergency Medicine
- Critical Care
Background:
- Standard external CPR (SECPR) has limitations in achieving adequate resuscitation rates after cardiac arrest.
- Open-chest CPR (OCCPR) and cardiopulmonary bypass (CPB) have shown promise in improving outcomes individually.
- A direct comparison of SECPR, OCCPR, and CPB in a relevant animal model is needed.
Purpose of the Study:
- To compare the efficacy of SECPR, OCCPR, and CPB in a canine model of myocardial infarction and ventricular fibrillation.
- To evaluate resuscitation rates, coronary perfusion pressure, and myocardial damage across the three techniques.
Main Methods:
- Twenty-six mongrel dogs were randomized into three groups: SECPR (n=9), CPB (n=9), and OCCPR (n=8).
- Following induced ventricular fibrillation and cardiac arrest, dogs received one of the three resuscitation techniques.
- Measurements included coronary perfusion pressure, epinephrine dosage, countershocks, and myocardial infarct size post-resuscitation.
Main Results:
- Resuscitation rates were significantly higher for CPB (9/9) and OCCPR (6/9) compared to SECPR (2/8) (P < .01).
- Coronary perfusion pressure was substantially higher with CPB and OCCPR than SECPR (P < .04).
- The ratio of necrotic to ischemic myocardium was significantly lower with CPB and OCCPR, indicating less myocardial damage.
Conclusions:
- OCCPR and CPB demonstrate superior coronary perfusion pressure and resuscitation rates compared to SECPR in this cardiac arrest model.
- Both CPB and OCCPR offer comparable resuscitation success, with CPB requiring less epinephrine.
- These findings support the potential clinical benefit of OCCPR and CPB in specific cardiac arrest scenarios.
Study Objectives:
After cardiac arrest, open-chest CPR (OCCPR) and cardiopulmonary bypass (CPB) have demonstrated higher resuscitation rates when compared individually with standard external CPR (SECPR). We compared all three techniques in a canine myocardial infarct ventricular fibrillation model.
Type Of Participants:
Twenty-six mongrel dogs were block-randomized to receive SECPR and advanced life support (nine), CPB (nine), or OCCPR (eight).
Design And Interventions:
All dogs received left anterior descending coronary artery occlusion followed by four minutes of ventricular fibrillation without CPR and eight minutes of Thumper CPR. At 12 minutes, dogs received one of three resuscitation techniques. After resuscitation, all animals received four hours of intensive care. Animals that were resuscitated had histochemical determination of ischemic and necrotic myocardial areas.
Measurements:
Intravascular pressures were measured and coronary perfusion pressure was calculated during baseline, cardiac arrest, resuscitation, and postresuscitation periods. Percent necrotic myocardium, percent ischemic myocardium, and necrotic-to-ischemic ratios were determined for resuscitated animals. Epinephrine dosage and number of countershocks were determined for each group.
Main Results:
Nine of nine CPB and six of nine OCCPR, compared with two of eight SECPR animals, were resuscitated (P less than .01). Three of nine CPB and OCCPR and two of eight SECPR dogs survived to four hours (P = NS). Coronary perfusion pressure two minutes after institution of technique was significantly higher with CPB (75 +/- 37 mm Hg) and OCCPR (56 +/- 31 mm Hg) than in SECPR animals (16 +/- 16 mm Hg, P less than .04). Epinephrine required for resuscitation was significantly less with CPB (0.10 +/- 0.02 mg/kg) than for SECPR (0.28 +/- 0.11 mg/kg, P less than .002). The ratio of necrotic to ischemic myocardium at four hours was significantly lower with CPB (0.15 +/- 0.31) and OCCPR (0.39 +/- 0.25) than for SECPR (1.16 +/- 0.31, P less than .02).
Conclusion:
OCCPR and CPB produce higher coronary perfusion pressures and improved resuscitation rates from ventricular fibrillation when compared with SECPR in this canine myocardial infarct cardiac arrest model. CPB and OCCPR yielded similar resuscitation results, although less epinephrine was required with CPB.
