Abstract 248: Prolonged Adult Cardiac Arrest With Enhanced Cardiopulmonary Resuscitation and Sodium Nitroprusside: A Case Series

Abstract

Introduction: Sudden cardiac death remains the leading cause of death in the United States, and overall survival with good neurological function nationally is about 8%. Prolonged refractory cardiac arrest requires an efficient method to maintain viability to the vital organs until a reversible cause, if present, can be treated. Sodium Nitroprusside Enhanced CPR, or SNPeCPR, is a new form of CPR consisting of active compression-decompression (ACD), impendence threshold device (ITD), abdominal binding, and large doses of sodium nitroprusside. We present here a series of 6 patients in whom these methods were utilized in the setting of cardiac arrest in the cardiac catheterization laboratory. Methods: 6 patients who suffered cardiac arrest (5 VT/VF and 1 PEA) and were treated for an average time of 32±12 minutes before arrival to the cardiac catheterization laboratory. Utilizing a LUCAS® device in combination with an ITD allowed for prolonged periods of CPR during which time percutaneous coronary intervention was performed to re-establish coronary blood flow. Abdominal binding was performed, and finally, alternating boluses of 2 and 1 mg of sodium nitroprusside for a total of 4 doses were given as treatment for no reflow in the coronary vascular bed throughout the duration of CPR. The etiology of the cardiac arrest was ostial LAD occlusion (4 cases), left main occlusion (1) contrast induced anaphylactic reaction and PEA (1). Results: Six patients were successfully treated with SNPeCPR. The mean time of CPR was 58±17 minutes. Hemodynamic measurements during CPR approached pre-arrest physiologic levels (mean±STD SBP/DBP was 88±23/38±12) . 5/6 patients survived to hospital discharge. All survivors had normal neurological function at hospital discharge and 1-month clinic follow up Cerebral Performance Category score of 1. Average LVEF at hospital discharge was 48±18 % . 4/5 survivors were alive at one year follow up. Conclusions: Sodium nitroprusside, in combination with mechanical adjuncts to CPR, is a safe and effective method of prolonged resuscitation. Further prospective studies will be required to further assess the efficacy of SNPeCPR in cases of prolonged cardiac arrest.