Resuscitation
-
Comparative Study
Pentoxifylline alone versus pentoxifylline combined with superoxide dismutase prolongs survival in a rat hemorrhagic shock model.
Pentoxifylline (PTX) and superoxide dismutase (SOD) have each proven effective in improving survival when administered during resuscitation in animal models of hemorrhagic shock. This study was conducted to determine if PTX and SOD combined would have synergistic effectiveness in the treatment of hemorrhagic shock. Sprague-Dawley rats (n = 40) were phlebotomized at 25 ml/kg for 2 min, then subjected to a 45-min ischemic period, and resuscitated with lactated Ringer's solution (LR) (50 ml/kg) over 1 h. ⋯ Animals were randomized into groups to receive one of the following agents during resuscitation: PTX in LR, SOD in LR, a combination of PTX and SOD in LR, or LR alone. PTX or SOD alone were effective in prolonging survival. However, the combination of PTX and SOD did not prolong survival above LR control.
-
Return of spontaneous circulation with CPR is a function of coronary perfusion pressure, which is determined by vasomotor tone and the force of compression. Vasomotor tone is affected by the relative stimulation of arterial vasoconstricting and vasorelaxing receptors by vasoactive substances. We measured the plasma levels of the endogenous vasoactive peptides arginine vasopressin (AVP) angiotensin II (ANG-II) and atrial natriuretic peptide (ANP) during cardiac arrest and resuscitation. ⋯ There were significant increases in the levels of these endogenous vasoactive peptides. This reflects the neuroendocrine response to global ischemia and CPR reperfusion. Plasma levels of these peptides may effect the vital organ perfusion pressures, response to exogenous vasopressors, and outcome of resuscitative efforts. Future therapies may be directed at enhancing or blocking the effect of these peptides so as to optimize perfusion pressure which is one of the principle determinants of outcome during CPR.
-
Comparative Study Clinical Trial
Effects of induced hypothermia in patients with septic adult respiratory distress syndrome.
To test the hypothesis that treatment with hypothermia affects the course of overwhelming acute respiratory failure associated with sepsis. ⋯ This study suggests that hypothermia was effective in improving oxygenation and survival in patients with severe ARDS associated with sepsis, even though VO2 was unchanged.
-
Standard two-resuscitator cardiopulmonary resuscitation (CPR) (one resuscitator providing Bag Valve Mask (BVM) ventilation and one chest compressions) was compared with a modified method where one resuscitator held the mask while the second provided ventilation and compressions. Twenty-two subjects used both methods in random order on a recording manikin equipped to measure minute volume (Vm), tidal volume (Vt), respiratory rate (RR), compression rate (CR) and depth. Vm and Vt were greater with modified CPR, but the CR was slower. ⋯ D. 37), > 51 mm 38% (S. D. 38)). Modified CPR greatly improves ventilation but reduces CR.
-
Epinephrine is used to increase coronary perfusion pressure and improve myocardial blood flow during cardiac arrest. Alternative vasopressors may have hemodynamic advantages over epinephrine. The purpose of this investigation was to test the effect of the vasopressor angiotensin II on myocardial blood flow in a swine model of cardiac arrest. ⋯ This fell to 15.1 +/- 19.9 with CPR alone, and rose to 66.9 +/- 69.8 following angiotensin II administration (P = 0.04; by two tailed T-test). Myocardial blood flow following ROSC further increased to 212.6 +/- 58.0. Angiotensin II in a dose of 50 micrograms/kg significantly increases myocardial blood flow in this model of cardiac arrest.