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- Georgios Sideris, Nikolaos Magkoutis, Alok Sharma, Jennifer Rees, Scott McKnite, Emily Caldwell, Mohammad Sarraf, Patrick Henry, Keith Lurie, Santiago Garcia, and Demetris Yannopoulos.
- Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France. Electronic address: georgios.sideris@lrb.aphp.fr.
- Resuscitation. 2014 Feb 1; 85 (2): 292-8.
BackgroundSurvival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. We hypothesize that early coronary reperfusion will improve 24h-survival and neurological outcomes.MethodsTotal occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5min, VF was induced and left untreated for 8min. If return of spontaneous circulation (ROSC) was achieved within 15min (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45min (group A) or 4h (group B) of LAD occlusion. Animals without ROSC after 15min of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45min of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10min of CPR had been performed. Primary endpoints for groups A and B were 24-h survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion.ResultsEarly compared to late reperfusion improved survival (10/11 versus 4/10, p=0.02), mean CPC (1.4±0.7 versus 2.5±0.6, p=0.017), LVEF (43±13 versus 32±9%, p=0.01), troponin I (37±28 versus 99±12, p=0.005) and CK-MB (11±4 versus 20.1±5, p=0.031) at 24-h after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C.ConclusionsEarly reperfusion after ischemic cardiac arrest improved 24h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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