Duration of Untreated Cardiac Arrest and Clinical Relevance of Animal Experiments: The Relationship between the "no-Flow" Duration and the Severity of Post-Cardiac Arrest Syndrome in a Porcine Model

Giovanni Babini, Luigi Grassi, Ilaria Russo, Deborah Novelli, Antonio Boccardo, Anita Luciani, Francesca Fumagalli, Lidia Staszewsky, Fabio Fiordaliso, Marcella De Maglie, Monica Salio, Davide D. Zani, Teresa Letizia, Serge Masson, Mario V. Luini, Davide Pravettoni, Eugenio Scanziani, Roberto Latini, Giuseppe Ristagno

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The study investigated the effect of untreated cardiac arrest (CA), that is, "no-flow" time, on postresuscitation myocardial and neurological injury, and survival in a pig model to identify an optimal duration that adequately reflects the most frequent clinical scenario. Methods: An established model of myocardial infarction followed by CA and cardiopulmonary resuscitation was used. Twenty-two pigs were subjected to three no-flow durations: short (8-10 min), intermediate (12-13 min), and long (14-15 min). Left ventricular ejection fraction (LVEF) was assessed together with thermodilution cardiac output (CO) and high sensitivity cardiac troponin T (hs-cTnT). Neurological impairment was evaluated by neurological scores, serum neuron specific enolase (NSE), and histopathology. Results: More than 60% of animals survived when the duration of CA was ≤13 min, compared to only 20% for a duration ≥14 min. Neuronal degeneration and neurological scores showed a trend toward a worse recovery for longer no-flow durations. No animals achieved a good neurological recovery for a no-flow ≥14 min, in comparison to a 56% for a duration ≤13 min (P = 0.043). Serum NSE levels significantly correlated with the no-flow duration (r = 0.892). Longer durations of CA were characterized by lower LVEF and CO compared to shorter durations (P < 0.05). The longer was the no-flow time, the higher was the number of defibrillations delivered (P = 0.043). The defibrillations delivered significantly correlated with LVEF and plasma hs-cTnT. Conclusions: Longer no-flow durations caused greater postresuscitation myocardial and neurological dysfunction and reduced survival. An untreated CA of 12-13 min may be an optimal choice for a clinically relevant model.

Original languageEnglish
Pages (from-to)205-212
Number of pages8
JournalShock
Volume49
Issue number2
DOIs
Publication statusPublished - Feb 1 2018

Keywords

  • Animal model
  • cardiac arrest
  • no-flow
  • outcome
  • postcardiac arrest syndrome

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

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