TY - JOUR
TI - Use of the impedance threshold device improves survival rate and neurological outcome in a swine model of asphyxial cardiac arrest*
AU - Pantazopoulos, I.N.
AU - Xanthos, T.T.
AU - Vlachos, I.
AU - Troupis, G.
AU - Kotsiomitis, E.
AU - Johnson, E.
AU - Papalois, A.
AU - Skandalakis, P.
JO - Pediatric Critical Care Medicine
PY - 2012
VL - 40
TODO - 3
SP - 861-868
PB - 
SN - 1529-7535
TODO - 10.1097/CCM.0b013e318232d8de
TODO - neuron specific enolase;  protein S 100, alertness;  animal experiment;  animal model;  aorta pressure;  article;  asphyxia;  asystole;  cardiovascular equipment;  controlled study;  coronary artery blood flow;  defibrillation;  device therapy;  experimental model;  experimental pig;  female;  heart arrest;  heart right atrium pressure;  heart ventricle fibrillation;  hemodynamic parameters;  impedance;  impedance threshold device;  laboratory test;  lung gas exchange;  male;  nonhuman;  outcome assessment;  priority journal;  prospective study;  resuscitation;  return of spontaneous circulation;  scoring system;  survival rate;  thorax pressure;  trachea obstruction, Animals;  Asphyxia;  Cardiopulmonary Resuscitation;  Disease Models, Animal;  Electric Impedance;  Female;  Heart Arrest;  Hemodynamics;  Male;  Nervous System Diseases;  Survival Rate;  Swine
TODO - OBJECTIVE: To assess whether intermittent impedance of inspiratory gas exchange improves hemodynamic parameters, 48-hr survival, and neurologic outcome in a swine model of asphyxial cardiac arrest treated with active compression-decompression cardiopulmonary resuscitation. DESIGN: Prospective, randomized, double-blind study. SETTING: Laboratory investigation. SUBJECTS: Thirty healthy Landrace/Large-White piglets of both sexes, aged 10 to 15 wks, whose average weight was 19 ± 2 kg. INTERVENTIONS: At approximately 7 mins following endotracheal tube clamping, ventricular fibrillation was induced and remained untreated for another 8 mins. Before initiation of cardiopulmonary resuscitation, animals were randomly assigned to either receive active compression-decompression cardiopulmonary resuscitation plus a sham impedance threshold device (control group, n = 15), or active compression-decompression cardiopulmonary resuscitation plus an active impedance threshold device (experimental group, n = 15). Electrical defibrillation was attempted every 2 mins until return of spontaneous circulation or asystole. MEASUREMENTS AND MAIN RESULTS: Return of spontaneous circulation was observed in six (40%) animals treated with the sham valve and 14 (93.3%) animals treated with the active valve (p = .005, odds ratio 21.0, 95% confidence interval 2.16-204.6). Neuron-specific enolase and S-100 levels increased in the ensuing 4 hrs post resuscitation in both groups, but they were significantly elevated in animals treated with the sham valve (p < .01). At 48 hrs, neurologic alertness score was significantly better in animals treated with the active valve (79.1 ± 18.7 vs. 50 ± 10, p < .05) and was strongly negatively correlated with 1- and 4-hr postresuscitation neuron-specific enolase (r = -.86, p < .001 and r = -.87, p < .001, respectively) and S-100 (r = -.77, p < .001 and r = -0.8, p = .001) values. CONCLUSIONS: In this model of asphyxial cardiac arrest, intermittent airway occlusion with the impedance threshold device during the decompression phase of active compression-decompression cardiopulmonary resuscitation significantly improved hemodynamic parameters, 24- and 48-hr survival, and neurologic outcome evaluated both with clinical and biochemical parameters (neuron-specific enolase, S-100). Copyright © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
ER -