PMID- 12969599
OWN - NLM
STAT- MEDLINE
DCOM- 20040401
LR  - 20190910
IS  - 0300-9572 (Print)
IS  - 0300-9572 (Linking)
VI  - 58
IP  - 3
DP  - 2003 Sep
TI  - The critical importance of minimal delay between chest compressions and 
      subsequent defibrillation: a haemodynamic explanation.
PG  - 249-58
AB  - Outcome after prehospital defibrillation remains dire. The aim of the present 
      study was to elucidate the pathophysiology of cardiac arrest and to suggest ways 
      to improve outcome. Ventricular fibrillation (VF) was induced in air-ventilated 
      pigs, after which ventilation was withdrawn. After 6.5 min of VF, ventilation 
      with 100% oxygen was initiated. In six pigs (group I), defibrillation was the 
      only treatment carried out. In another six pigs (group II), mechanical chest 
      compression-decompression CPR (mCPR) was carried out for 3.5 min followed by a 
      40-s hands-off period before defibrillation. If unsuccessful, mCPR was resumed 
      for a further 30 s before a second or a third, 40-s delayed, shock was given. In 
      a final six pigs (group III) mCPR was applied for 3.5 min after which up to three 
      shocks (if needed) were given during on-going mCPR. Return of spontaneous 
      circulation (ROSC) occurred in none of the pigs in group I (0%), in 1 of six pigs 
      in group II (17%) and in five of six pigs in group III (83%). During the first 3 
      min of VF arterial blood was transported to the venous circulation, with the 
      consequence that the left ventricle emptied and the right ventricle became 
      greatly distended. It took 2 min of mCPR to establish an adequate coronary 
      perfusion pressure, which was lost when the mCPR was interrupted. During 30 s of 
      mCPR coronary perfusion pressure was negative, but a carotid flow of about 25% of 
      basal value was obtained. In this pig model, VF caused venous congestion, an 
      empty left heart, and a greatly distended right heart within 3 min. Adequate 
      heart massage before and during defibrillation greatly improved the likelihood of 
      return of spontaneous circulation (ROSC).
FAU - Steen, Stig
AU  - Steen S
AD  - Heart-Lung Division, University Hospital of Lund, SE-221 85 Lund, Sweden. 
      stig.steen@thorax.lu.se
FAU - Liao, Qiuming
AU  - Liao Q
FAU - Pierre, Leif
AU  - Pierre L
FAU - Paskevicius, Audrius
AU  - Paskevicius A
FAU - Sjoberg, Trygve
AU  - Sjoberg T
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Ireland
TA  - Resuscitation
JT  - Resuscitation
JID - 0332173
SB  - IM
CIN - Resuscitation. 2003 Sep;58(3):237-47. PMID: 12969598
MH  - Animals
MH  - Cardiopulmonary Resuscitation/*methods
MH  - Coronary Circulation/*physiology
MH  - Disease Models, Animal
MH  - Electric Countershock/*methods
MH  - Heart Arrest/complications/*therapy
MH  - Hemodynamics
MH  - Swine
MH  - Ventricular Fibrillation/etiology/*therapy
EDAT- 2003/09/13 05:00
MHDA- 2004/04/02 05:00
CRDT- 2003/09/13 05:00
PHST- 2003/09/13 05:00 [pubmed]
PHST- 2004/04/02 05:00 [medline]
PHST- 2003/09/13 05:00 [entrez]
AID - S030095720300265X [pii]
AID - 10.1016/s0300-9572(03)00265-x [doi]
PST - ppublish
SO  - Resuscitation. 2003 Sep;58(3):249-58. doi: 10.1016/s0300-9572(03)00265-x.