Early coronary revascularization improves 24h survival and neurological function after ischemic cardiac arrest. A randomized animal study

Georgios Sideris; Nikolaos Magkoutis; Alok Sharma; Jennifer Rees; Scott McKnite; Emily Caldwell; Mohammad Sarraf; Patrick Henry; Keith Lurie; Santiago Garcia; Demetris Yannopoulos

doi:10.1016/j.resuscitation.2013.10.023

Early coronary revascularization improves 24h survival and neurological function after ischemic cardiac arrest. A randomized animal study

Resuscitation. 2014 Feb;85(2):292-8. doi: 10.1016/j.resuscitation.2013.10.023. Epub 2013 Nov 5.

Affiliations

¹ Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France. Electronic address: [email protected].
² Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France.
³ University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States.
⁴ University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States. Electronic address: [email protected].

PMID: 24200891
PMCID: PMC3989142
DOI: 10.1016/j.resuscitation.2013.10.023

Abstract

Background: Survival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. We hypothesize that early coronary reperfusion will improve 24h-survival and neurological outcomes.

Methods: Total occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5min, VF was induced and left untreated for 8min. If return of spontaneous circulation (ROSC) was achieved within 15min (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45min (group A) or 4h (group B) of LAD occlusion. Animals without ROSC after 15min of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45min of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10min of CPR had been performed. Primary endpoints for groups A and B were 24-h survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion.

Results: Early compared to late reperfusion improved survival (10/11 versus 4/10, p=0.02), mean CPC (1.4±0.7 versus 2.5±0.6, p=0.017), LVEF (43±13 versus 32±9%, p=0.01), troponin I (37±28 versus 99±12, p=0.005) and CK-MB (11±4 versus 20.1±5, p=0.031) at 24-h after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C.

Conclusions: Early reperfusion after ischemic cardiac arrest improved 24h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.

Keywords: 24h Survival rate; ACD; ACLS; CK-MB; CPC; CPR; Cerebral performance category (CPC) score; Early coronary revascularization; ITD; OHCA; ROSC; Return of spontaneous circulation (ROSC).; VF; VT; active compression decompression; advanced cardiac life support; cardiopulmonary resuscitation; cerebral performance category; creatine kinase-MB; impendence threshold device; out of hospital cardiac arrest; return of spontaneous circulation; ventricular fibrillation; ventricular tachycardia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Amiodarone / pharmacology
Animals
Cardiac Catheterization
Cardiopulmonary Resuscitation / methods*
Disease Models, Animal
Echocardiography
Electric Countershock
Electrocardiography
Epinephrine / pharmacology
Female
Heart Arrest / surgery*
Heart Arrest / therapy
Monitoring, Physiologic
Random Allocation
Respiration, Artificial
Survival Rate
Swine

Substances

Amiodarone
Epinephrine

Grants and funding

R01 HL108926/HL/NHLBI NIH HHS/United States