Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

Hdl Handle:
http://hdl.handle.net/10147/146370
Title:
Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.
Authors:
McCaul, Conán; Kornecki, Alik; Engelberts, Doreen; McNamara, Patrick; Kavanagh, Brian P
Affiliation:
Department of Critical Care Medicine, Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada.
Citation:
Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine. 2009, 109 (4):1202-8 Anesth. Analg.
Journal:
Anesthesia and analgesia
Issue Date:
Oct-2009
URI:
http://hdl.handle.net/10147/146370
DOI:
10.1213/ANE.0b013e3181b278a3
PubMed ID:
19762750
Abstract:
Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.; Anesthetized Sprague-Dawley rats were exposed to 1 min of asphyxial cardiac arrest. Resuscitation was standardized and consisted of chest compressions, oxygen (Fio(2) 1.0), and IV epinephrine 30 microg/kg (Series 1) and 10 microg/kg (Series 2). Left ventricular function was assessed by echocardiography (Series 1), and animals were randomized to receive either 5 cm H(2)O PEEP or zero PEEP at commencement of CPR and throughout resuscitation. Survival was defined as the presence of a spontaneous circulation 60 or 120 min (Series 2) after initial resuscitation.; There were no baseline differences between the groups. In Series 1, administration of 5 cm H(2)O PEEP (Fio(2) 1.0 and 0.21) was associated with improved survival compared with zero PEEP (7/9 and 6/6 vs 0/9, P < 0.01 and <0.001, respectively). Application of 5 cm H(2)O PEEP (Fio(2) 1.0) increased left ventricular end-diastolic area, systemic oxygenation, and functional residual capacity. Use of PEEP during CPR did not adversely affect left ventricular systolic function or arterial blood pressure. The outcome differences were not due to increased oxygenation because the rank order of survival was 5 cm H(2)O PEEP (Fio(2) 1.0) approximately 5 cm H(2)O PEEP (Fio(2) 0.21) > zero PEEP (Fio(2) 1.0), whereas the rank order of Pao(2) was 5 cm H(2)O PEEP (Fio(2) 1.0) > 5 cm H(2)O PEEP (Fio(2) 0.21) approximately zero PEEP (Fio(2) 1.0). In an additional series in which epinephrine 10 microg/kg was used (Series 2), the survival was 100% with no beneficial effects of PEEP.; In asphyxial cardiac arrest in a small rodent model, continuous application of PEEP (5 cm H(2)O) during and after CPR had beneficial effects on survival that were independent of oxygenation and without adverse cardiovascular effects.
Language:
en
MeSH:
Adrenergic Agonists; Animals; Asphyxia; Cardiopulmonary Resuscitation; Disease Models, Animal; Epinephrine; Functional Residual Capacity; Heart Arrest; Hemodynamics; Injections, Intravenous; Male; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Pulmonary Edema; Rats; Rats, Sprague-Dawley; Respiratory Mechanics; Time Factors; Ventricular Function, Left
ISSN:
1526-7598

Full metadata record

DC FieldValue Language
dc.contributor.authorMcCaul, Conánen
dc.contributor.authorKornecki, Aliken
dc.contributor.authorEngelberts, Doreenen
dc.contributor.authorMcNamara, Patricken
dc.contributor.authorKavanagh, Brian Pen
dc.date.accessioned2011-10-21T11:12:58Z-
dc.date.available2011-10-21T11:12:58Z-
dc.date.issued2009-10-
dc.identifier.citationPositive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine. 2009, 109 (4):1202-8 Anesth. Analg.en
dc.identifier.issn1526-7598-
dc.identifier.pmid19762750-
dc.identifier.doi10.1213/ANE.0b013e3181b278a3-
dc.identifier.urihttp://hdl.handle.net/10147/146370-
dc.description.abstractMultiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.-
dc.description.abstractAnesthetized Sprague-Dawley rats were exposed to 1 min of asphyxial cardiac arrest. Resuscitation was standardized and consisted of chest compressions, oxygen (Fio(2) 1.0), and IV epinephrine 30 microg/kg (Series 1) and 10 microg/kg (Series 2). Left ventricular function was assessed by echocardiography (Series 1), and animals were randomized to receive either 5 cm H(2)O PEEP or zero PEEP at commencement of CPR and throughout resuscitation. Survival was defined as the presence of a spontaneous circulation 60 or 120 min (Series 2) after initial resuscitation.-
dc.description.abstractThere were no baseline differences between the groups. In Series 1, administration of 5 cm H(2)O PEEP (Fio(2) 1.0 and 0.21) was associated with improved survival compared with zero PEEP (7/9 and 6/6 vs 0/9, P < 0.01 and <0.001, respectively). Application of 5 cm H(2)O PEEP (Fio(2) 1.0) increased left ventricular end-diastolic area, systemic oxygenation, and functional residual capacity. Use of PEEP during CPR did not adversely affect left ventricular systolic function or arterial blood pressure. The outcome differences were not due to increased oxygenation because the rank order of survival was 5 cm H(2)O PEEP (Fio(2) 1.0) approximately 5 cm H(2)O PEEP (Fio(2) 0.21) > zero PEEP (Fio(2) 1.0), whereas the rank order of Pao(2) was 5 cm H(2)O PEEP (Fio(2) 1.0) > 5 cm H(2)O PEEP (Fio(2) 0.21) approximately zero PEEP (Fio(2) 1.0). In an additional series in which epinephrine 10 microg/kg was used (Series 2), the survival was 100% with no beneficial effects of PEEP.-
dc.description.abstractIn asphyxial cardiac arrest in a small rodent model, continuous application of PEEP (5 cm H(2)O) during and after CPR had beneficial effects on survival that were independent of oxygenation and without adverse cardiovascular effects.-
dc.language.isoenen
dc.subject.meshAdrenergic Agonists-
dc.subject.meshAnimals-
dc.subject.meshAsphyxia-
dc.subject.meshCardiopulmonary Resuscitation-
dc.subject.meshDisease Models, Animal-
dc.subject.meshEpinephrine-
dc.subject.meshFunctional Residual Capacity-
dc.subject.meshHeart Arrest-
dc.subject.meshHemodynamics-
dc.subject.meshInjections, Intravenous-
dc.subject.meshMale-
dc.subject.meshOxygen Inhalation Therapy-
dc.subject.meshPositive-Pressure Respiration-
dc.subject.meshPulmonary Edema-
dc.subject.meshRats-
dc.subject.meshRats, Sprague-Dawley-
dc.subject.meshRespiratory Mechanics-
dc.subject.meshTime Factors-
dc.subject.meshVentricular Function, Left-
dc.titlePositive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.en
dc.contributor.departmentDepartment of Critical Care Medicine, Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada.en
dc.identifier.journalAnesthesia and analgesiaen
dc.description.provinceLeinster-

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