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Published on: January 30, 2020
Cardiac resuscitability with cardiopulmonary bypass after increasing ventricular fibrillation times in dogs
1International Resuscitation Research Center, University of Pittsburgh, Pennsylvania 15260.
Insights
Cardiopulmonary bypass (CPB) shows promise for resuscitating dogs from prolonged cardiac arrest when standard methods fail. However, success is limited by the duration of cardiac arrest before CPB initiation.
Area of Science:
- Cardiovascular Research
- Emergency Medicine
- Veterinary Science
Background:
- Standard advanced cardiac life support (ACLS) has limitations in achieving conscious survival after prolonged cardiac arrest.
- Previous canine studies suggest cardiopulmonary bypass (CPB) may improve resuscitation outcomes compared to ACLS.
Purpose of the Study:
- To compare the effectiveness of CPB in cardiovascular resuscitation after varying durations of cardiac arrest without prior circulatory support.
- To evaluate the impact of arrest duration on the success of CPB-assisted resuscitation in a canine model.
Main Methods:
- Canine subjects were subjected to ventricular fibrillation for 15, 20, or 30 minutes without artificial support.
- Following the arrest period, all subjects received total CPB, followed by defibrillation and partial CPB for up to four hours.
- Epinephrine was administered during CPB to assess its effect on coronary perfusion pressure and ventricular fibrillation amplitude.
Main Results:
- CPB with epinephrine significantly improved coronary perfusion pressure and ventricular fibrillation amplitude across all groups.
- Dogs experiencing 15 or 20 minutes of arrest (Groups 1 and 2) were successfully weaned from CPB with stable spontaneous circulation.
- Dogs experiencing 30 minutes of arrest (Group 3) showed reduced success rates for weaning from CPB, with significant myocardial necrosis and early mortality.
Conclusions:
- Cardiopulmonary bypass demonstrates potential value in managing prolonged cardiac arrest, particularly when ACLS is ineffective or unavailable.
- The duration of cardiac arrest significantly impacts the success of CPB-assisted resuscitation, with longer periods leading to poorer outcomes.
- CPB may offer a critical intervention for selected cases of prolonged cardiac arrest, but its efficacy is time-dependent.
Abstract:
Previous studies in dogs have shown resuscitation from prolonged cardiac arrest to conscious survival to be more effective with the use of cardiopulmonary bypass (CPB) than with standard advanced cardiac life support. This study compared cardiovascular resuscitability with CPB only after varying periods of cardiac arrest without artificial circulatory support in a canine model. Group 1 (ten) was subjected to ventricular fibrillation for 15 minutes; group 2 (ten) for 20 minutes; and group 3 (ten) for 30 minutes. All received total CPB after ventricular fibrillation without advanced cardiac life support to defibrillation at two to five minutes and partial CPB to four hours. In all three groups CPB with epinephrine generated normal coronary perfusion pressure and increased ventricular fibrillation amplitude significantly. In groups 1 and 2, CPB reperfusion allowed for successful defibrillation in less than five minutes, weaning from CPB in all dogs at four hours, and stable spontaneous circulation thereafter. In group 3, only five of ten dogs could be weaned from bypass at four hours, and all died early with myocardial necroses. It was concluded that CPB may be of value in the setting of prolonged cardiac arrest when advanced cardiac life support has not been provided or is unable to restore spontaneous heart-beat.
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