Intrathoracic Pressure Regulator During
Continuous-Chest-Compression Advanced Cardiac Resuscitation Improves Vital
Organ Perfusion Pressures in a Porcine Model of Cardiac Arrest
Demetris Yannopoulos, MD; Vinay M. Nadkarni, MD; Scott H. McKnite, BS; Anu Rao, MD; Kurt Kruger, BS; Anja
Metzger, PhD; David G. Benditt, MD; Keith G. Lurie, MD
From the Departments of
Cardiology (D.Y.), Cardiac Arrhythmia Center, Cardiovascular Division (D.G.B.,
K.G.L.), Department of Medicine (A.R., D.G.B.), and Department of Emergency
Medicine and Internal Medicine (K.G.L.), University of Minnesota, Minneapolis
(D.Y.); Department of Anesthesia and Critical Care Medicine, Children’s
Hospital of Philadelphia, Philadelphia, Pa (V.M.N.); Minnesota Medical Research
Foundation, Hennepin County Medical Center, Minneapolis (S.H.N.); and Advanced
Circulatory Systems Incorporation, Eden Prairie, Minn
(K.K., A.M.).
Reprint requests to Keith
G. Lurie, MD, Minneapolis Medical Research
Foundation, 914 S 8th St, 3rd Floor, Minneapolis, MN 55404. E-mail klurie@advancedcirculatory.com
Received December 19, 2004; de novo received February 7, 2005; revision received April 14, 2005; accepted April 25, 2005.
Background— A novel device, the intrathoracic
pressure regulator (ITPR), combines an inspiratory
impedance threshold device (ITD) with a vacuum source for the
generation of controlled –10 mm Hg vacuum in the trachea during
cardiopulmonary resuscitation (CPR) while allowing positive pressure
ventilation. Compared with standard (STD) CPR, ITPR-CPR will enhance venous return, systemic arterial
pressure, and vital organ perfusion in both porcine models of
ventricular fibrillation and hypovolemic cardiac
arrest.
Methods and Results— In protocol 1, 20 pigs (weight, 30±0.5 kg)
were randomized to STD-CPR or ITPR-CPR. After 8 minutes of
untreated ventricular fibrillation, CPR was performed for 6 minutes
at 100 compressions per minute and positive pressure ventilation
(100% O2) with a compression-to-ventilation ratio of
15:2. In protocol 2, 6 animals were bled 50% of their blood volume.
After 4 minutes of untreated ventricular fibrillation, interventions
were performed for 2 minutes with STD-CPR and 2 minutes of ITPR-CPR. This sequence was repeated.
In protocol 3, 6 animals after 8 minutes of untreated VF were
treated with ITPR-CPR for 15 minutes, and arterial and venous blood
gases were collected at baseline and minutes 5, 10, and 15 of CPR.
A newer, leak-proof ITPR device was used. Aortic, right atrial, endotracheal
pressure, intracranial pressure, and end-tidal CO2 values
were measured (mm Hg); common carotid arterial flow also was
measured (mL/min). Coronary perfusion pressure
(diastolic; aortic minus right atrial
pressure) and cerebral perfusion pressure (mean arterial minus mean
intracranial pressure) were calculated. Unpaired Student t
test and Friedman’s repeated-measures ANOVA of ranks were used in
protocols 1 and 3. A 2-tailed Wilcoxon signed-rank
test was used for analysis in protocol 2. Fischer’s exact test was
used for survival. Significance was set at P<0.05. Vital
organ perfusion pressures and end-tidal CO2 were significantly improved
with ITPR-CPR in both protocols. In protocol 1, 1-hour survival was
100% with ITPR-CPR and 10% with STD-CPR (P=0.001).
Arterial blood pH was significantly lower and PaCO2 was significantly higher
with ITPR- CPR in protocol 1. Arterial oxygen saturation was 100%
throughout the study in both protocols. PaCO2 and PaO2 remained
stable, but metabolic acidosis progressed, as expected, throughout
the 15 minutes of CPR in protocol 3.
Conclusions— Compared with STD-CPR, use of ITPR-CPR improved hemodynamics
and short-term survival rates after cardiac arrest.