Minimal interruption of cardiopulmonary resuscitation for a single shock as mandated by automated external defibrillations does not compromise outcomes in a porcine model of cardiac arrest and resuscitation

Giuseppe Ristagno, Wanchun Tang, James K. Russell, Dawn Jorgenson, Hao Wang, Shijie Sun, Max Harry Weil

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVES:: Current automated external defibrillations require interruptions in chest compressions to avoid artifacts during electrocardiographic analyses and to minimize the risk of accidental delivery of an electric shock to the rescuer. The earlier three-shock algorithm, with prolonged interruptions of chest compressions, compromised outcomes and increased severity of postresuscitation myocardial dysfunction. In the present study, we investigated the effect of timing of minimal automated external defibrillation-mandated interruptions of chest compressions on cardiopulmonary resuscitation outcomes, using a single-shock algorithm. We hypothesized that an 8-sec interruption of chest compressions for a single shock, as mandated by automated external defibrillations, would not impair initial resuscitation and outcomes of cardiopulmonary resuscitation. DESIGN:: Randomized prospective animal study. SETTING:: University affiliated research laboratory. SUBJECTS:: Domestic pigs. MEASUREMENTS AND MAIN RESULTS:: In 24 domestic male pigs weighing 41 ± 2 kg, ventricular fibrillation was induced by left anterior descending coronary artery occlusion and untreated for 7 min. Cardiopulmonary resuscitation, including chest compressions and ventilation with oxygen, was then performed for an interval of 2 min before attempted defibrillation. Animals were randomized into three groups: A) interruption immediately before defibrillation; B) interruption after 1 min of cardiopulmonary resuscitation; or C) no interruption. Chest compressions were delivered with the aid of a mechanical chest compressor at a rate of 100 compressions/min and compression/ventilation ratio of 30:2. Defibrillation was attempted with a single biphasic 150-J shock. Each animal was successfully resuscitated and survived for >72 hr. No differences in the number of shocks before return of spontaneous circulation, frequency of recurrent ventricular fibrillation, duration of cardiopulmonary resuscitation, and severity of postresuscitation myocardial dysfunction were observed. CONCLUSIONS:: In this experimental model of cardiac arrest and cardiopulmonary resuscitation, minimal automated external defibrillation-mandated interruption of chest compressions for a single-shock algorithm did not have adverse effects on postresuscitation myocardial or neurologic function. All animals, whether subjected to cardiopulmonary resuscitation interruptions or not, survived.

Original languageEnglish
Pages (from-to)3048-3053
Number of pages6
JournalCritical Care Medicine
Volume36
Issue number11
DOIs
Publication statusPublished - Nov 2008

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Cardiopulmonary Resuscitation
Heart Arrest
Resuscitation
Shock
Swine
Thorax
Sus scrofa
Ventricular Fibrillation
Ventilation
Coronary Occlusion
Artifacts
Nervous System
Coronary Vessels
Theoretical Models
Prospective Studies
Oxygen
Research

Keywords

  • Automated external defribillation
  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Chest compressions
  • Defibrillation
  • Myocardial function
  • Outcome
  • Survival
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Minimal interruption of cardiopulmonary resuscitation for a single shock as mandated by automated external defibrillations does not compromise outcomes in a porcine model of cardiac arrest and resuscitation. / Ristagno, Giuseppe; Tang, Wanchun; Russell, James K.; Jorgenson, Dawn; Wang, Hao; Sun, Shijie; Weil, Max Harry.

In: Critical Care Medicine, Vol. 36, No. 11, 11.2008, p. 3048-3053.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVES:: Current automated external defibrillations require interruptions in chest compressions to avoid artifacts during electrocardiographic analyses and to minimize the risk of accidental delivery of an electric shock to the rescuer. The earlier three-shock algorithm, with prolonged interruptions of chest compressions, compromised outcomes and increased severity of postresuscitation myocardial dysfunction. In the present study, we investigated the effect of timing of minimal automated external defibrillation-mandated interruptions of chest compressions on cardiopulmonary resuscitation outcomes, using a single-shock algorithm. We hypothesized that an 8-sec interruption of chest compressions for a single shock, as mandated by automated external defibrillations, would not impair initial resuscitation and outcomes of cardiopulmonary resuscitation. DESIGN:: Randomized prospective animal study. SETTING:: University affiliated research laboratory. SUBJECTS:: Domestic pigs. MEASUREMENTS AND MAIN RESULTS:: In 24 domestic male pigs weighing 41 ± 2 kg, ventricular fibrillation was induced by left anterior descending coronary artery occlusion and untreated for 7 min. Cardiopulmonary resuscitation, including chest compressions and ventilation with oxygen, was then performed for an interval of 2 min before attempted defibrillation. Animals were randomized into three groups: A) interruption immediately before defibrillation; B) interruption after 1 min of cardiopulmonary resuscitation; or C) no interruption. Chest compressions were delivered with the aid of a mechanical chest compressor at a rate of 100 compressions/min and compression/ventilation ratio of 30:2. Defibrillation was attempted with a single biphasic 150-J shock. Each animal was successfully resuscitated and survived for >72 hr. No differences in the number of shocks before return of spontaneous circulation, frequency of recurrent ventricular fibrillation, duration of cardiopulmonary resuscitation, and severity of postresuscitation myocardial dysfunction were observed. CONCLUSIONS:: In this experimental model of cardiac arrest and cardiopulmonary resuscitation, minimal automated external defibrillation-mandated interruption of chest compressions for a single-shock algorithm did not have adverse effects on postresuscitation myocardial or neurologic function. All animals, whether subjected to cardiopulmonary resuscitation interruptions or not, survived.",
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AU - Russell, James K.

AU - Jorgenson, Dawn

AU - Wang, Hao

AU - Sun, Shijie

AU - Weil, Max Harry

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N2 - OBJECTIVES:: Current automated external defibrillations require interruptions in chest compressions to avoid artifacts during electrocardiographic analyses and to minimize the risk of accidental delivery of an electric shock to the rescuer. The earlier three-shock algorithm, with prolonged interruptions of chest compressions, compromised outcomes and increased severity of postresuscitation myocardial dysfunction. In the present study, we investigated the effect of timing of minimal automated external defibrillation-mandated interruptions of chest compressions on cardiopulmonary resuscitation outcomes, using a single-shock algorithm. We hypothesized that an 8-sec interruption of chest compressions for a single shock, as mandated by automated external defibrillations, would not impair initial resuscitation and outcomes of cardiopulmonary resuscitation. DESIGN:: Randomized prospective animal study. SETTING:: University affiliated research laboratory. SUBJECTS:: Domestic pigs. MEASUREMENTS AND MAIN RESULTS:: In 24 domestic male pigs weighing 41 ± 2 kg, ventricular fibrillation was induced by left anterior descending coronary artery occlusion and untreated for 7 min. Cardiopulmonary resuscitation, including chest compressions and ventilation with oxygen, was then performed for an interval of 2 min before attempted defibrillation. Animals were randomized into three groups: A) interruption immediately before defibrillation; B) interruption after 1 min of cardiopulmonary resuscitation; or C) no interruption. Chest compressions were delivered with the aid of a mechanical chest compressor at a rate of 100 compressions/min and compression/ventilation ratio of 30:2. Defibrillation was attempted with a single biphasic 150-J shock. Each animal was successfully resuscitated and survived for >72 hr. No differences in the number of shocks before return of spontaneous circulation, frequency of recurrent ventricular fibrillation, duration of cardiopulmonary resuscitation, and severity of postresuscitation myocardial dysfunction were observed. CONCLUSIONS:: In this experimental model of cardiac arrest and cardiopulmonary resuscitation, minimal automated external defibrillation-mandated interruption of chest compressions for a single-shock algorithm did not have adverse effects on postresuscitation myocardial or neurologic function. All animals, whether subjected to cardiopulmonary resuscitation interruptions or not, survived.

AB - OBJECTIVES:: Current automated external defibrillations require interruptions in chest compressions to avoid artifacts during electrocardiographic analyses and to minimize the risk of accidental delivery of an electric shock to the rescuer. The earlier three-shock algorithm, with prolonged interruptions of chest compressions, compromised outcomes and increased severity of postresuscitation myocardial dysfunction. In the present study, we investigated the effect of timing of minimal automated external defibrillation-mandated interruptions of chest compressions on cardiopulmonary resuscitation outcomes, using a single-shock algorithm. We hypothesized that an 8-sec interruption of chest compressions for a single shock, as mandated by automated external defibrillations, would not impair initial resuscitation and outcomes of cardiopulmonary resuscitation. DESIGN:: Randomized prospective animal study. SETTING:: University affiliated research laboratory. SUBJECTS:: Domestic pigs. MEASUREMENTS AND MAIN RESULTS:: In 24 domestic male pigs weighing 41 ± 2 kg, ventricular fibrillation was induced by left anterior descending coronary artery occlusion and untreated for 7 min. Cardiopulmonary resuscitation, including chest compressions and ventilation with oxygen, was then performed for an interval of 2 min before attempted defibrillation. Animals were randomized into three groups: A) interruption immediately before defibrillation; B) interruption after 1 min of cardiopulmonary resuscitation; or C) no interruption. Chest compressions were delivered with the aid of a mechanical chest compressor at a rate of 100 compressions/min and compression/ventilation ratio of 30:2. Defibrillation was attempted with a single biphasic 150-J shock. Each animal was successfully resuscitated and survived for >72 hr. No differences in the number of shocks before return of spontaneous circulation, frequency of recurrent ventricular fibrillation, duration of cardiopulmonary resuscitation, and severity of postresuscitation myocardial dysfunction were observed. CONCLUSIONS:: In this experimental model of cardiac arrest and cardiopulmonary resuscitation, minimal automated external defibrillation-mandated interruption of chest compressions for a single-shock algorithm did not have adverse effects on postresuscitation myocardial or neurologic function. All animals, whether subjected to cardiopulmonary resuscitation interruptions or not, survived.

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KW - Cardiac arrest

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KW - Myocardial function

KW - Outcome

KW - Survival

KW - Ventricular fibrillation

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