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Standardized model of porcine resuscitation using a custom-made resuscitation board results in optimal hemodynamic management

  • Jakob Wollborn
    Affiliations
    Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Germany

    Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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  • Eva Ruetten
    Affiliations
    Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Germany

    Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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  • Bjoern Schlueter
    Affiliations
    Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Germany

    Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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  • Joerg Haberstroh
    Affiliations
    Division of Experimental Surgery, Center for Experimental Models and Transgenic Services, Germany

    Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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  • Author Footnotes
    1 Both authors contributed equally.
    Ulrich Goebel
    Correspondence
    Corresponding author at: Department for Anesthesiology and Critical Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
    Footnotes
    1 Both authors contributed equally.
    Affiliations
    Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Germany

    Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
    Search for articles by this author
  • Author Footnotes
    1 Both authors contributed equally.
    Martin A. Schick
    Footnotes
    1 Both authors contributed equally.
    Affiliations
    Department of Anesthesiology and Critical Care, Medical Center – University of Freiburg, Germany

    Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
    Search for articles by this author
  • Author Footnotes
    1 Both authors contributed equally.
Published:January 19, 2018DOI:https://doi.org/10.1016/j.ajem.2018.01.059

      Abstract

      Aim

      Standardized modeling of cardiac arrest and cardiopulmonary resuscitation (CPR) is crucial to evaluate new treatment options. Experimental porcine models are ideal, closely mimicking human-like physiology. However, anteroposterior chest diameter differs significantly, being larger in pigs and thus poses a challenge to achieve adequate perfusion pressures and consequently hemodynamics during CPR, which are commonly achieved during human resuscitation. The aim was to prove that standardized resuscitation is feasible and renders adequate hemodynamics and perfusion in pigs, using a specifically designed resuscitation board for a pneumatic chest compression device.

      Methods and results

      A “porcine-fit” resuscitation board was designed for our experiments to optimally use a pneumatic compression device (LUCAS® II, Physio-Control Inc.), which is widely employed in emergency medicine and ideal in an experimental setting due to its high standardization. Asphyxial cardiac arrest was induced in 10 German hybrid landrace pigs and cardiopulmonary resuscitation was performed according to ERC/AHA 2015 guidelines with mechanical chest compressions. Hemodynamics were measured in the carotid and pulmonary artery. Furthermore, arterial blood gas was drawn to assess oxygenation and tissue perfusion.
      The custom-designed resuscitation board in combination with the LUCAS® device demonstrated highly sufficient performance regarding hemodynamics during CPR (mean arterial blood pressure, MAP 46 ± 1 mmHg and mean pulmonary artery pressure, mPAP of 36 ± 1 mmHg over the course of CPR). MAP returned to baseline values at 2 h after ROSC (80 ± 4 mmHg), requiring moderate doses of vasopressors. Furthermore, stroke volume and contractility were analyzed using pulse contour analysis (106 ± 3 ml and 1097 ± 22 mmHg/s during CPR). Blood gas analysis revealed CPR-typical changes, normalizing in the due course. Thermodilution parameters did not show persistent intravascular volume shift.

      Conclusion

      Standardized cardiopulmonary resuscitation is feasible in a porcine model, achieving adequate hemodynamics and consecutive tissue perfusion of consistent quality.

      Keywords

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