Resuscitation
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Since adrenaline (epinephrine) also has negative effects during and after cardiopulmonary resuscitation (CPR) a non-adrenergic vasoconstrictor like endothelin might be an alternative to increase vital organ blood flow. We studied the effect of different doses of endothelin-1 compared with adrenaline on the ability to resuscitate, cerebral and myocardial blood flow (MBF) in a closed chest cardiac arrest pig model. After 5 min of ventricular fibrillation, CPR with a ventilator and a mechanical compression device was started. ⋯ There was no difference in MBF between the treatment groups despite a higher coronary perfusion pressure (CoPP) in the endothelin-1 groups. Restoration of spontaneous circulation could be only achieved in the endothelin-1 50 microg (3 of 7; 43%) and 100 microg (5 of 7; 71%) group. This study suggests that endothelin-1 enhances CBF during CPR better than adrenaline and increases resuscitation success.
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This study examined (1) the defibrillation efficacy of using a minimally invasive direct cardiac massage (MID-CM) device as one electrode of the defibrillation electrical circuit and (2) the effect on external defibrillation of defibrillating when the MID-CM device is in place and a pneumothorax is present. ⋯ Using the MID-CM device as one electrode of the defibrillation circuit markedly lowers the DFT compared with that for standard transthoracic defibrillation for both a monophasic and biphasic waveform. Defibrillation with the device in place and the chest opened elevates the DFT for external defibrillation much more during end-expiration than during end-inspiration.