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Early volume expansion during cardiopulmonary resuscitation
S J Jameson1, J R Mateer, D J DeBehnke
1Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee 53226.
Objective:
To determine if hemodynamic parameters, return of spontaneous circulation (ROSC), and short term survival are improved by volume expansion during resuscitation from ventricular fibrillation cardiac arrest.
Design:
Randomized protocol.
Setting:
Animal research laboratory.
Participants:
18 conventional swine.
Interventions:
Ventricular fibrillation was electrically induced after instrumentation. All swine fibrillated without intervention for 5 min and received 13 min of mechanical high-impulse (HICPR) prior to randomization. The resuscitation protocol included either epinephrine (0.014 mg/kg) alone (Group A) or epinephrine with a fluid bolus (4 cc/kg) of hypertonic saline-dextran (HSD) solution (Group B).
Measurements And Main Results:
Group A had 6/9 and Group B had 5/9 swine achieve ROSC and 2/9 vs. 4/9 swine survived 30 min, respectively (P = NS). Coronary perfusion pressures (CPP) measured during HICPR at 60, 90, and 120 s after infusion were not significantly different for the two groups. At 1 min after ROSC, CPP, aortic systolic blood pressure (AoSBP), and aortic diastolic pressure (AoDBP) were all significantly greater in Group B than in Group A (P < 0.05). Arterial and venous blood gases measured at 1 min after ROSC revealed a significantly lower pH and higher PCO2 in Group B animals.
Conclusion:
Early volume expansion with epinephrine during HICPR does not improve CPP, rate of ROSC, or rate of short term survival from VF arrest in this porcine model. HSD volume expansion does improve systemic hemodynamics after ROSC with increased CPP, AoSBP, and AoDBP. Improved tissue perfusion in Group B animals after ROSC is suggested by a decreased pH and increased PCO2 presumably secondary to enhanced mobilization of lactate and PCO2 from tissues.