Abstract | BACKGROUND: Some clinical studies have suggested that chest compressions before defibrillation improve survival in cardiac arrest because of prolonged ventricular fibrillation (VF; ie, within the circulatory phase). Animal data have also supported this conclusion, and we have previously demonstrated that preshock chest compressions increase the VF median frequency and improve the likelihood of a return of spontaneous circulation in normal swine. We hypothesized that chest compressions before defibrillation in a swine model of acute myocardial ischemia would also increase VF median frequency and improve resuscitation outcome. METHODS AND RESULTS: Twenty-six swine were subjected to balloon occlusion of the left anterior descending coronary artery for 2 hours. The balloon was removed and VF was induced and untreated for 8 minutes. Swine were then treated with up to 3 stacked defibrillation shocks (n=13, shock-first group) or 3 minutes of chest compressions before shock (n=13, preshock cardiopulmonary resuscitation group). In the preshock cardiopulmonary resuscitation group, median frequency was increased from 7.0+/-0.8 to 13.9+/-1.6 Hz after chest compressions (P=0.002). Despite the improved median frequency in the preshock cardiopulmonary resuscitation group, 24-hour survival with favorable neurological status was significantly worse in the preshock cardiopulmonary resuscitation group (1/13) compared with the shock-first group (8/13, P=0.01). CONCLUSIONS: In a swine model of prolonged VF in acute myocardial ischemia, 24-hour survival with favorable neurological status was more likely when defibrillation was performed first without preceding chest compressions. Myocardial substrate is an important factor in determining the optimal resuscitation strategy.
|
Authors | Julia H Indik, Ronald W Hilwig, Mathias Zuercher, Karl B Kern, Marc D Berg, Robert A Berg |
Journal | Circulation. Arrhythmia and electrophysiology
(Circ Arrhythm Electrophysiol)
Vol. 2
Issue 2
Pg. 179-84
(Apr 2009)
ISSN: 1941-3084 [Electronic] United States |
PMID | 19808463
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
|
Topics |
- Acute Disease
- Animals
- Cardiopulmonary Resuscitation
(adverse effects, methods)
- Coronary Circulation
- Coronary Stenosis
(therapy)
- Disease Models, Animal
- Electric Countershock
(methods)
- Female
- Myocardial Ischemia
(therapy)
- Sus scrofa
- Ventricular Fibrillation
(therapy)
|