@article{3126144,
    title = "Correlation of Impedance Threshold Device use during cardiopulmonary resuscitation with post-cardiac arrest Acute Kidney Injury",
    author = "Niforopoulou, P. and Iacovidou, N. and Lelovas, P. and Karlis, G. and Papalois, Α. and Siakavellas, S. and Spapis, V. and Kaparos, G. and Siafaka, I. and Xanthos, T.",
    journal = "The American Journal of Emergency Medicine",
    year = "2017",
    volume = "35",
    number = "6",
    pages = "846-854",
    publisher = "W.B. Saunders",
    issn = "0735-6757",
    doi = "10.1016/j.ajem.2017.01.040",
    keywords = "interleukin 18;  neutrophil gelatinase associated lipocalin;  biological marker;  epinephrine;  interleukin 18;  neutrophil gelatinase associated lipocalin, acute kidney failure;  animal experiment;  animal model;  aortic pressure;  Article;  controlled study;  coronary artery blood flow;  CPR feedback device;  diastolic blood pressure;  experimental ventricular fibrillation;  female;  heart arrest;  impedance threshold device;  kidney blood flow;  life support equipment;  mean arterial pressure;  mechanical chest compressor;  nonhuman;  piglet;  priority journal;  protein blood level;  protein urine level;  resuscitation;  return of spontaneous circulation;  tidal volume;  acute kidney failure;  animal;  complication;  devices;  disease model;  heart arrest;  hemodynamics;  impedance;  physiologic monitoring;  pig;  resuscitation;  urine;  Ventricular Fibrillation, Acute Kidney Injury;  Animals;  Biomarkers;  Cardiopulmonary Resuscitation;  Disease Models, Animal;  Electric Impedance;  Epinephrine;  Female;  Heart Arrest;  Hemodynamics;  Interleukin-18;  Lipocalin-2;  Monitoring, Physiologic;  Swine;  Ventricular Fibrillation",
    abstract = "Purpose To assess whether use of Impedance Threshold Device (ITD) during cardiopulmonary resuscitation (CPR) reduces the degree of post-cardiac arrest Acute Kidney Injury (AKI), as a result of improved hemodynamics, in a porcine model of ventricular fibrillation (VF) cardiac arrest. Methods After 8 min of untreated cardiac arrest, the animals were resuscitated either with active compression-decompression (ACD) CPR plus a sham ITD (control group, n = 8) or with ACD-CPR plus an active ITD (ITD group, n = 8). Adrenaline was administered every 4 min and electrical defibrillation was attempted every 2 min until return of spontaneous circulation (ROSC) or asystole. After ROSC the animals were monitored for 6 h under general anesthesia and then returned to their cages for a 48 h observation, before euthanasia. Two novel biomarkers, Neutrophil Gelatinase-Associated Lipocalin (NGAL) in plasma and Interleukin-18 (IL-18) in urine, were measured at 2 h, 4 h, 6 h, 24 h and 48 h post-ROSC, in order to assess the degree of AKI. Results ROSC was observed in 7 (87.5%) animals treated with the sham valve and 8 (100%) animals treated with the active valve (P = NS). However, more than twice as many animals survived at 48 h in the ITD group (n = 8, 100%) compared to the control group (n = 3, 37.5%). Urine IL-18 and plasma NGAL levels were augmented post-ROSC in both groups, but they were significantly higher in the control group compared with the ITD group, at all measured time points. Conclusion Use of ITD during ACD-CPR improved hemodynamic parameters, increased 48 h survival and decreased the degree of post-cardiac arrest AKI in the resuscitated animals. © 2017 Elsevier Inc."
}