Sodium Nitroprusside-Enhanced Cardiopulmonary Resuscitation Improves Blood Flow by Pulmonary Vasodilation Leading to Higher Oxygen Requirements

Adrian Ripeckyj; Marinos Kosmopoulos; Kadambari Shekar; Claire Carlson; Rajat Kalra; Jennifer Rees; Tom P Aufderheide; Jason A Bartos; Demetris Yannopoulos

doi:10.1016/j.jacbts.2019.11.010

Sodium Nitroprusside-Enhanced Cardiopulmonary Resuscitation Improves Blood Flow by Pulmonary Vasodilation Leading to Higher Oxygen Requirements

JACC Basic Transl Sci. 2020 Feb 5;5(2):183-192. doi: 10.1016/j.jacbts.2019.11.010. eCollection 2020 Feb.

Authors

Affiliations

¹ Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota.
² Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
³ Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.

Abstract

Sodium nitroprusside-enhanced cardiopulmonary resuscitation has shown superior resuscitation rates and neurologic outcomes in large animal models supporting the need for a randomized human clinical trial. This study is the first to show nonselective pulmonary vasodilation as a potential mechanism for the hemodynamic benefits. The pulmonary shunting that is created requires increased oxygen treatment, but the overall improvement in blood flow increases minute oxygen delivery to tissues. In this context, hypoxemia is an important safety endpoint and a 100% oxygen ventilation strategy may be necessary for the first human clinical trial.

Keywords: A-a, alveolar-arterial; ACLS, advanced cardiac life support; BLS, basic life support; CBF, carotid blood flow; CPP, coronary perfusion pressure; CPR, cardiopulmonary resuscitation; FiO2, fraction of inspired oxygen; ITD, impedance threshold device; ROSC, return of spontaneous circulation; SNP, sodium nitroprusside; SNPeCPR, sodium nitroprusside–enhanced cardiopulmonary resuscitation; VF, ventricular fibrillation; cardiopulmonary resuscitation; coronary perfusion pressure; lactic acid; pulmonary vasodilation; sodium nitroprusside.