Hemodynamic improvement of a LUCAS 2 automated device by addition of an impedance threshold device in a pig model of cardiac arrest

Hemodynamic improvement of a LUCAS 2 automated device by addition of an impedance threshold device in a pig model of cardiac arrest

Debaty G1, Segal N2, Matsuura T3, Fahey B4, Wayne M5, Mahoney B6, Frascone R7, Lick C8, Yannopoulos D9Resuscitation. 2014 Dec;85(12):1704-7.

Source : 1Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States; UJF-Grenoble 1/CNRS/CHU de Grenoble/TIMC-IMAG UMR 5525, Grenoble, France; 2AP-HP, Hôpital Lariboisière, Services des Urgences, Univ Paris Diderot, Sorbonne Paris Cité, UMRS 942, F-75018 Paris, France; 3Department of Integrated Biology & Physiology, Medical School, University of Minnesota, Minneapolis, MN, United States; 4Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States; 5Whatcom County Emergency Medical Services, Department of Emergency Medicine, PeaceHealth St. Joseph Medical Center, Bellingham, WA, United States; 6Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States; 7Department of Emergency Medicine, Regions Hospital, St. Paul, MN, United States; 8Allina Health Emergency Medical Services, St. Paul, MN, United States; 9Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States. Electronic address: yanno001@umn.edu.

Abstract : INTRODUCTION : The combination of the LUCAS 2 (L-CPR) automated CPR device and an impedance threshold device (ITD) has been widely implemented in the clinical field. This animal study tested the hypothesis that the addition of an ITD on L-CPR would enhance cerebral and coronary perfusion pressures. METHODS : Ten female pigs (39.0±2.0kg) were sedated, intubated, anesthetized with isofluorane, and paralyzed with succinylcholine (93.3μg/kg/min) to inhibit the potential confounding effect of gasping. After 4min of untreated ventricular fibrillation, 4min of L-CPR+an active ITD or L-CPR+a sham ITD was initiated and followed by another 4min of the alternative method of CPR. Systolic blood pressure (SBP), diastolic blood pressure (DBP), diastolic right atrial pressure (RAP), intracranial pressure (ICP), airway pressure, and end tidal CO2 (ETCO2) were recorded continuously. Data expressed as mean mmHg±SD. RESULTS : Decompression phase airway pressure was significantly lower with L-CPR+active ITD versus L-CPR+sham ITD (-5.3±2.2 vs. -0.5±0.6; p<0.001). L-CPR+active ITD treatment resulted in significantly improved hemodynamics versus L-CPR+sham ITD: ETCO2, 35±6 vs. 29±7 (p=0.015); SBP, 99±9 vs. 93±15 (p=0.050); DBP, 24±12 vs. 19±15 (p=0.006); coronary perfusion pressure, 29±8 vs. 26±7 (p=0.004) and cerebral perfusion pressure, 24±13 vs. 21±12 (p=0.028). CONCLUSIONS : In pigs undergoing L-CPR the addition of the active ITD significantly reduced intrathoracic pressure and increased vital organ perfusion pressures.