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Change in out-of-hospital 12-lead ECG diagnostic classification following resuscitation from cardiac arrest - Archive ouverte HAL
Article Dans Une Revue Resuscitation Année : 2021

Change in out-of-hospital 12-lead ECG diagnostic classification following resuscitation from cardiac arrest

Tom Aufderheide
  • Fonction : Auteur
Thomas Engel
  • Fonction : Auteur
Hadi Saleh
  • Fonction : Auteur
David Gutterman
  • Fonction : Auteur
Benjamin Weston
  • Fonction : Auteur
Paul Pepe
  • Fonction : Auteur
John Baker
  • Fonction : Auteur
Jacob Labinski
  • Fonction : Auteur
Lujia Tang
  • Fonction : Auteur
Aniko Szabo
  • Fonction : Auteur
Rajat Kalra
  • Fonction : Auteur
Demetris Yannopoulos
  • Fonction : Auteur
M. Riccardo Colella
  • Fonction : Auteur

Résumé

Adrenaline is recommended for cardiac arrest resuscitation, but its effectiveness has been questioned recently. Achieving return of spontaneous circulation (ROSC) is essential and is obtained by increasing coronary perfusion pressure (CPP) after adrenaline injection. A threshold as high as 35 mmHg of CPP may be necessary to obtain ROSC, but increasing doses of adrenaline might be harmful to the brain. Our study aimed to compare the increase in CPP with reduced doses of adrenaline to the recommended 1 mg dose in a pig model of cardiac arrest. Fifteen domestic pigs were randomized into three groups according to the adrenaline doses: 1 mg, 0.5 mg, or 0.25 mg administered every 5 min. Cardiac arrest was induced by ventricular fibrillation; after 5 min of no-flow, mechanical chest compression was resumed. The Wilcoxon test and Kruskal–Wallis exact test were used for the comparison of groups. Fisher’s exact test was used to compare categorical variables. CPP, EtCO2 level, cerebral, and tissue near-infrared spectroscopy (NIRS) were measured. CPP was significantly lower in the 0.25 mg group 90 s after the first adrenaline injection: 28.9 (21.2; 35.4) vs. 53.8 (37.8; 58.2) in the 1 mg group (p = 0.008), while there was no significant difference with 0.5 mg 39.6 (32.7; 52.5) (p = 0.056). Overall, 0.25 mg did not achieve the threshold of 35 mmHg. EtCO2 levels were higher at T12 and T14 in the 0.5 mg than in the standard group: 32 (23; 35) vs. 19 (16; 26) and 26 (20; 34) vs. 19 (12; 22) (p < 0.05). Cerebral and tissue NIRS did not show a significant difference between the three groups. CPP after 0.5 mg boluses of adrenaline was not significantly different from the recommended 1 mg in our model of cardiac arrest.

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Dates et versions

hal-04805063 , version 1 (26-11-2024)

Identifiants

Citer

Tom Aufderheide, Thomas Engel, Hadi Saleh, David Gutterman, Benjamin Weston, et al.. Change in out-of-hospital 12-lead ECG diagnostic classification following resuscitation from cardiac arrest. Resuscitation, 2021, 169 (20), pp.45-52. ⟨10.1016/j.resuscitation.2021.10.012⟩. ⟨hal-04805063⟩
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