Abstract
Ischemia-induced left ventricular (LV) wall thickening compromises the hemodynamic effectiveness of cardiopulmonary resuscitation (CPR). However, accurate assessment of the severity of ischemia-induced LV wall thickening during CPR is challenging. We investigated, in a swine model, whether hemodynamic parameters, including end-tidal carbon dioxide (ETCO2) level, are linearly associated with the severity of ischemia-induced LV wall thickening during CPR of consistent quality. We retrospectively analyzed 96 datasets for ETCO2 level, arterial pressure, LV wall thickness, and the percent of measured end-diastolic volume (%EDV) relative to EDV at the onset of ventricular fibrillation from eight pigs. Animals underwent advanced cardiovascular life support based on resuscitation guidelines. During CPR, LV wall thickness progressively increased while %EDV progressively decreased. Systolic and diastolic arterial pressure and ETCO2 level were significantly correlated with LV wall thickness and %EDV. Linear mixed effect models revealed that, after adjustment for significant covariates, systolic and diastolic arterial pressure were not associated with LV wall thickness or %EDV. ETCO2 level had a significant linear relationship with %EDV (P = 0.004). However, it could explain only 28.2% of the total variance of %EDV in our model. In conclusion, none of the hemodynamic parameters examined in this study appeared to provide sufficient information on the severity of ischemia-induced LV wall thickening.
Highlights
More than 50 years have passed since the introduction of modern cardiopulmonary resuscitation (CPR) [1]
We investigated, in a swine model of out-of-hospital cardiac arrest, whether hemodynamic parameters, including arterial pressure and ETCO2 level, are linearly associated with the severity of ischemia-induced left ventricular (LV) wall thickening during CPR of consistent quality, and can be utilized as a tool to estimate the severity of ischemia-induced LV wall thickening during advanced cardiovascular life support (ACLS) performed according to resuscitation guidelines
During CPR, LV wall thickness progressively increased while %end-diastolic volume (EDV) progressively decreased
Summary
More than 50 years have passed since the introduction of modern cardiopulmonary resuscitation (CPR) [1]. A tremendous number of studies have been performed to enhance understanding of cardiac arrest and CPR. Many aspects of cardiac arrest pathophysiology remain to be determined. CPR is performed to generate enough blood flow to sustain vital organs until restoration of spontaneous circulation (ROSC). Several studies have reported that progressive left ventricular.
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