Hypertonic versus isotonic crystalloid infusion for cerebral perfusion pressure in a porcine experimental cardiac arrest model |
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| Affiliation: | 1. Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea;2. Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea;3. Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea;4. Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea;5. Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea;1. Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China;2. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom;3. Hepato-pancreato-biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China;4. Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China;1. Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA;2. Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA;3. Michigan Center for Integrative Research in Critical Care, Ann Arbor, MI, USA;4. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA;1. Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy;2. Department of Emergency Medicine, Policlinico Univeristario di Verona, Azienda Ospedaliera Universitaria integrata, Verona, Italy;3. Department of Emergency Medicine, Girolamo Fracastoro Hospital of San Bonifacio, Azienda Ospedaliera Scaligera, San Bonifacio, Verona, Italy;4. Department of Emergency Medicine, Hospital Civile Maggiore, Azienda Ospedaliera Universitaria integrata, Verona, Italy;5. Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy;6. Franz Tappeiner Hospital, Azienda Sanitaria dell''Alto Adige, Department of Emergency Medicine Franz Tappeiner Hospital, Azienda Sanitaria dell''Alto Adige, Italy;1. Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Pasadena, CA 91101, USA;2. Department of Urology, Southern California Permanente Medical Group, 4867 Sunset Boulevard, Los Angeles, CA 90027, USA;3. Regional Reference Laboratories, Southern California Permanente Medical Group, 11668 Sherman Way, North Hollywood, CA 91605, USA;4. Department of Quality and Clinical Analysis, Southern California Permanente Medical Group, 393 East Walnut Street, Pasadena, CA 91188, USA;5. Currently with the Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, 313 North Figueroa Street, Los Angeles, California 90012, USA |
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| Abstract: | BackgroundThe effect of intravenous (IV) fluid administration type on cerebral perfusion pressure (CePP) during cardiopulmonary resuscitation (CPR) is controversial. The purpose of this study was to evaluate the association between IV fluid type and CePP in a porcine cardiac arrest model.MethodsWe randomly assigned 12 pigs to the hypertonic crystalloid, isotonic crystalloid and no-fluid groups. After 4 min of untreated ventricular fibrillation (VF), chest compression was conducted for 2 cycles (CC only). Chest compression with IV fluid infusion (CC + IV) was followed for 2 cycles. Advanced life support, including defibrillation and epinephrine, was added for 8 cycles (ALS phase). Mean arterial pressure (MAP), intracranial pressure (ICP) and CePP were measured. A paired t-test was used to measure the mean difference in CePP.ResultsTwelve pigs underwent the experiment. The hypertonic crystalloid group showed higher CePP values than those demonstrated by the isotonic crystalloid group from ALS cycles 2 to 8. The MAP values in the hypertonic group were higher than those in the isotonic group starting at ALS cycle 2. The ICP values in the hypertonic group were lower than those in the isotonic group starting at ALS cycle 4. From ALS cycles 2 to 8, the reduction in the mean difference in the isotonic group was larger than that in the other groups.ConclusionIn a VF cardiac arrest porcine study, the hypertonic crystalloid group showed higher CePP values by maintaining higher MAP values and lower ICP values than those of the isotonic crystalloid group. |
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