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Augmented efficacy of external CPR by intermittent occlusion of the ascending aorta
Tang, Wanchun ...
BACKGROUND. After prolonged cardiac arrest, conventional methods of closed-chest cardiac compression are ineffective. This is primarily because offailure to generate minimal threshold levels of ...coronary perfusion pressure for cardiac resuscitation. This report introduces a new option for cardiac resuscitation by use of a combination of intermittent ascending aortic balloonocclusion, aortic infusion, and precordial compression to increase the pressure gradient for coronary perfusion. METHODS AND RESULTS. Twenty anesthetized, mechanically ventilated, normovolemic domestic pigs were investigated. A 10F balloon catheter was advanced from the left femoral arteryinto the ascending aorta. Ventricular fibrillation was induced with an AC current delivered through an electrode catheter advanced into the right ventricle. Precordial compression was initiated after 7 minutes of untreated ventricular fibrillation. The animals were randomized to one of four groups: (1) balloon occlusion with proximal infusion of oxygenated saline, (2) balloonocclusion alone, (3) proximal aortic infusion together with epinephrinewithout balloon occlusion, and (4) injection of epinephrine withoutballoon occlusion or proximal infusion. For balloon occlusion, the balloon was inflated for 30 seconds during each minute of cardiopulmonary resuscitation. In the subsets of animals that received infusions, oxygenated saline (30 mL) was injected into the proximal aorta immediately after balloon occlusion. Epinephrine was used in two subsets: It was injected as a bolus in amounts of 30 micrograms/kg into the right atrium at 30 seconds after start ofprecordial compression and repeated as required to maintain coronary perfusion pressure within the range of 25 to 30 mm Hg. Defibrillation was attempted at 1 minute after start of precordial compression and at 1-minute intervals thereafter.(trunc.)
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