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Post-resuscitation haemodynamics in a novel acute myocardial infarction cardiac arrest model in the pig

Published online by Cambridge University Press:  01 July 2007

T. Palmaers ,
S. Albrecht ,
C. Leuthold ,
F. Heuser ,
J. Schuettler  and
B. Schmitz
T. Palmaers
Affiliation:
Friedrich-Alexander University of Erlangen-Nuremberg, University Hospital Erlangen, Department of Anaesthesiology, Erlangen, Germany
S. Albrecht
Affiliation:
Friedrich-Alexander University of Erlangen-Nuremberg, University Hospital Erlangen, Department of Anaesthesiology, Erlangen, Germany
C. Leuthold
Affiliation:
Friedrich-Alexander University of Erlangen-Nuremberg, University Hospital Erlangen, Department of Anaesthesiology, Erlangen, Germany
F. Heuser
Affiliation:
Friedrich-Alexander University of Erlangen-Nuremberg, University Hospital Erlangen, Department of Anaesthesiology, Erlangen, Germany
J. Schuettler
Affiliation:
Friedrich-Alexander University of Erlangen-Nuremberg, University Hospital Erlangen, Department of Anaesthesiology, Erlangen, Germany
B. Schmitz*
Affiliation:
Friedrich-Alexander University of Erlangen-Nuremberg, University Hospital Erlangen, Department of Anaesthesiology, Erlangen, Germany Centre Hospitalier de Luxembourg, Department of Anesthesiology and Intensive Care Medicine, Luxembourg, Luxembourg
*
Correspondence to: Dr Bernd Schmitz, Département Anesthésie-Réanimation, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210 Luxembourg, Luxembourg. E-mail: [email protected]; Tel: +352 4411 2335; Fax: +352 4412 50
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Summary

Background and objectives

Although a considerable amount of promising experimental research has been performed on cardiopulmonary resuscitation, clinical data indicate an ongoing limited outcome in human beings. One reason for this discrepancy could be that experimental studies use healthy animals whereas most human beings undergoing cardiopulmonary resuscitation suffer from acute or chronic myocardial dysfunction. To overcome this problem, we sought to develop a new model of myocardial infarction, that is easy to perform in all kind of laboratories and compromises on the myocardial function significantly.

Methods

Following approval by the local authorities, 14 domestic pigs were instrumented for measurement of arterial, central venous, left atrial and left ventricular pressures. Myocardial infarction was induced in eight pigs by clipping the circumflex artery close to its origin from the left coronary artery (infarction group; n = 8). Six animals (no infarction group, n = 6) served as no-infarct controls. Following a 4-min period of cardiac arrest, internal cardiac massage was performed in these two groups, and haemodynamics were recorded during the first 30 min of reperfusion.

Results

All animals were resuscitated successfully. Compared to the no-infarction group, the infarction group showed significantly decreased myocardial contractility, coronary perfusion pressure and cardiac index (30 min after restoration of spontaneous circulation: infarction group: 57 ± 7 and 89 ± 19 mL min−1 kg−1 in the no-infarction group; mean ± SD; P < 0.05) during reperfusion. Two animals from the infarction group (25%), but none of the animals in the no-infarction group, died during the reperfusion period.

Conclusion

These data demonstrate that clipping of the circumflex artery leads to a reduced myocardial performance after successful resuscitation, whereas the rate of restoration of spontaneous circulation is not reduced. Therefore, this set-up provides a reproducible model for future studies of post-resuscitation haemodynamics and treatment.

Keywords

HEART ARRESTCARDIOPULMONARY RESUSCITATIONMODELS, ANIMAL, pigMYOCARDIAL INFARCTIONREPERFUSION INJURY
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 7 , July 2007 , pp. 580 - 588
Copyright
Copyright © European Society of Anaesthesiology 2007

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Footnotes

Presented in part at the German Anaesthesia Congress (DAC 2004) June 2004, Nuremberg, Germany and at the Congress of the European Society of Anaesthesiology (ESA 2004), May 2004, Lisbon, Portugal.

References

1.Bottiger, BW, Teschendorf, P, Krumnikl, JJ et al. . Global cerebral ischemia due to cardiocirculatory arrest in mice causes neuronal degeneration and early induction of transcription factor genes in the hippocampus. Brain Res Mol Brain Res 1999; 65: 135–142.CrossRefGoogle ScholarPubMed
2.Eleff, S, Kim, H, Shaffner, D, Traystman, R, Koehler, R. Effect of cerebral blood flow generated during cardiopulmonary resuscitation in dogs on maintenance versus recovery of ATP and pH. Stroke 1993; 24: 2066–2073.Google Scholar
3.Fischer, M, Bockhorst, K, Hoehn-Berlage, M, Schmitz, B, Hossmann, KA. Imaging of the apparent diffusion coefficient for the evaluation of cerebral metabolic recovery after cardiac arrest. Magn Reson Imag 1995; 13: 781–790.CrossRefGoogle ScholarPubMed
4.Schmitz, B, Bottiger, BW, Hossmann, KA. Functional activation of cerebral blood flow after cardiac arrest in rat. J Cereb Blood Flow Metab 1997; 17: 1202–1209.CrossRefGoogle ScholarPubMed
5.Wenzel, V, Linder, KH, Augenstein, S, Prengel, AW, Strohmenger, HU. Vasopressin combined with epinephrine decreases cerebral perfusion compared with vasopressin alone during cardiopulmonary resuscitation in pigs. Stroke 1998; 29: 1462–1467.CrossRefGoogle ScholarPubMed
6.Brunette, DD, Jameson, SJ. Comparison of standard versus high-dose epinephrine in the resuscitation of cardiac arrest in dogs. Ann Emerg Med 1990; 19: 8–11.CrossRefGoogle ScholarPubMed
7.Calle, PA. Pharmacological influences on cardiopulmonary arrest-related brain damage in the rat. Verh K Acad Geneeskd Belg 1993; 55: 123–144.Google ScholarPubMed
8.Fischer, M, Dahmen, A, Standop, J, Hagendorff, A, Hoeft, A, Krep, H. Effects of hypertonic saline on myocardial blood flow in a porcine model of prolonged cardiac arrest. Resuscitation 2002; 54: 269–280.CrossRefGoogle Scholar
9.Hoekstra, JW, Van-Ligten, P, Neumar, R, Werman, HA, Anderson, J, Brown, CG. Effect of high dose norepinephrine versus epinephrine on cerebral and myocardial blood flow during CPR. Resuscitation 1990; 19: 227–240.CrossRefGoogle ScholarPubMed
10.Schindler, I, Mauritz, W, Weindlmayr-Goettel, M, Steinbereithner, K. Effects of nimodipine administration during cardiopulmonary resuscitation in pigs. Eur J Anaesthesiol 1992; 9: 411–418.Google ScholarPubMed
11.Cohen, TJ, Goldner, BG, Maccaro, PC et al. . A comparison of active compression-decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital. N Engl J Med 1993; 329: 1918–1921.CrossRefGoogle ScholarPubMed
12.Dean, JM, Koehler, RC, Schleien, CL et al. . Improved blood flow during prolonged cardiopulmonary resuscitation with 30% duty cycle in infant pigs. Circulation 1991; 84: 896–904.CrossRefGoogle ScholarPubMed
13.Halperin, H, Guerci, A, Chandra, N et al. . Vest inflation without simultaneous ventilation during cardiac arrest in dogs: improved survival from prolonged cardiopulmonary resuscitation. Circulation 1986; 74: 1407–1415.CrossRefGoogle ScholarPubMed
14.Becker, LB, Ostrander, MP, Barrett, J, Kondos, GT. Outcome of CPR in a large metropolitan area – where are the survivors? Ann Emerg Med 1991; 20: 355–361.CrossRefGoogle Scholar
15.Beuret, P, Feihl, F, Vogt, P, Perret, A, Romand, JA, Perret, C. Cardiac arrest: prognostic factors and outcome at one year. Resuscitation 1993; 25: 171–179.CrossRefGoogle ScholarPubMed
16.Brison, RJ, Davidson, JR, Dreyer, JF et al. . Cardiac arrest in Ontario: circumstances, community response, role of prehospital defibrillation and predictors of survival. Can Med Assoc J 1992; 147: 191–199.Google ScholarPubMed
17.Brown, CG, Martin, DR, Pepe, PE et al. . A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. The Multicenter High-Dose Epinephrine Study Group. N Engl J Med 1992; 327: 1051–1055.CrossRefGoogle ScholarPubMed
18.Callaham, M, Madsen, CD, Barton, CW, Saunders, CE, Pointer, J. A randomized clinical trial of high-dose epinephrine and norepinephrine vs. standard-dose epinephrine in prehospital cardiac arrest. JAMA 1992; 268: 2667–2672.CrossRefGoogle ScholarPubMed
19.Fischer, M, Fischer, NJ, Schuttler, J. One-year survival after out-of-hospital cardiac arrest in Bonn city: outcome report according to the ‘Utstein style’. Resuscitation 1997; 33: 233–243.Google Scholar
20.Stiell, IG, Hebert, PC, Weitzman, BN et al. . High-dose epinephrine in adult cardiac arrest. N Engl J Med 1992; 327: 1045–1050.CrossRefGoogle ScholarPubMed
21.Wenzel, V, Krismer, AC, Arntz, HR, Sitter, H, Stadlbauer, KH, Lindner, KH. A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 2004; 350: 105–113.CrossRefGoogle ScholarPubMed
22.Engdahl, J, Bang, A, Karlson, BW, Lindqvist, J, Herlitz, J. Characteristics and outcome among patients suffering from out of hospital cardiac arrest of non-cardiac aetiology. Resuscitation 2003; 57: 33–41.CrossRefGoogle ScholarPubMed
23.Myerburg, RJ. Sudden cardiac death: epidemiology, causes, and mechanisms. Cardiology 1987; 2: 2–9.CrossRefGoogle Scholar
24.Silfvast, T. Cause of death in unsuccessful prehospital resuscitation. J Intern Med 1991; 229: 331–335.CrossRefGoogle ScholarPubMed
25.Thomas, AC, Knapman, PA, Krikler, DM, Davies, MJ. Community study of the causes of ‘natural’ sudden death. BMJ 1988; 297: 1453–1456.CrossRefGoogle ScholarPubMed
26.Kern, KB, Lancaster, L, Goldman, S, Ewy, GA. The effect of coronary artery lesions on the relationship between coronary perfusion pressure and myocardial blood flow during cardiopulmonary resuscitation in pigs. Am Heart J 1990; 120: 324–333.Google Scholar
27.Kern, KB, Ewy, GA. Minimal coronary stenoses and left ventricular blood flow during CPR. Ann Emerg Med 1992; 21: 1066–1072.Google Scholar
28.Prengel, AW, Lindner, KH, Keller, A, Lurie, KG. Cardiovascular function during the postresuscitation phase after cardiac arrest in pigs: a comparison of epinephrine versus vasopressin. Crit Care Med 1996; 24: 2014–2019.Google Scholar
29.Dantzer, R, Mormede, P. The behaviour of swine and its relevance to cardiovascular research. In: Stanton, HC, Mersmann, HJ, eds. Swine in Cardiovascular Research, Vol. 1. Boca Raton, FL: CRC-Press Inc., 1986: 61ff.Google Scholar
30.Konietzke, D, Gervais, H, Dick, W, Hennes, HJ. Modelle und Methoden in der tierexperimentellen Reanimation. Anaesthesist 1988; 37: 140.Google Scholar
31.DeBehnke, DJ, Angelos, MG, Leasure, JE. Comparison of standard external CPR, open-chest CPR, and cardiopulmonary bypass in a canine myocardial infarct model. Ann Emerg Med 1991; 20: 754–760.CrossRefGoogle Scholar
32.Berg, RA, Kern, KB, Hilwig, RW, Ewy, GA. Assisted ventilation during ‘bystander’ CPR in a swine acute myocardial infarction model does not improve outcome. Circulation 1997; 96: 4364–4371.Google Scholar
33.Fischer, M, Hossmann, KA. Volume expansion during cardiopulmonary resuscitation reduces cerebral no-reflow. Resuscitation 1996; 32: 227–240.CrossRefGoogle ScholarPubMed
34.Schmitz, B, Fischer, M, Bockhorst, K, Hoehn-Berlage, M, Hossmann, KA. Resuscitation from cardiac arrest in cats: influence of epinephrine dosage on brain recovery. Resuscitation 1995; 30: 251–262.Google Scholar
35.Gazmuri, RJ, Weil, MH, Bisera, J, Tang, W, Fukui, M, McKee, D. Myocardial dysfunction after successful resuscitation from cardiac arrest. Crit Care Med 1996; 24: 992–1000.CrossRefGoogle ScholarPubMed
36.Lindner, KH, Brinkmann, A, Pfenninger, EG, Lurie, KG, Goertz, A, Lindner, IM. Effect of vasopressin on hemodynamic variables, organ blood flow, and acid–base status in a pig model of cardiopulmonary resuscitation. Anesth Analg 1993; 77: 427–435.Google Scholar