Objective: To evaluate the effects of quality of non-standard cardiopulmonary resuscitation (N-CPR) and new guidelines recommended standard CPR (S-CPR) on post-resuscitation inflammatory reaction in a cardiac arrest (CA) porcine model.
Methods: Eighteen pigs were randomly divided into two groups, and ventricular fibrillation (VF) was induced by programmed electrical stimulation after giving anesthesia, intubation tube and mechanical ventilation. S-CPR (n=9): CPR was consistent with recommendation of the 2005 guidelines. N-CPR (n=9): given CPR with low quality CPR usually instituted in clinic. After 4 minutes of untreated VF, CPR was started for 9 minutes. Defibrillation and advanced life support were attempted at 13 minutes of CA. All resuscitated animals were supported with intensive care equipment for 4 hours, and then experimental indexes were observed. Animals were sacrificed if they survived for 24 hours, and tissues of cerebral cortex, cardiac muscle, kidney, and liver were harvested for immunohistochemistry to evaluate the expression of nuclear factor-KappaB (NF-KappaB). The changes in hemodynamics was measured at CPR 3, 6, and 9 minutes, and the serum levels of tumor necrosis factor (TNF-alpha), interleukin-1 beta (IL-1 beta) were determined before CA, CPR 9 minutes, and 4 hours after restoration of spontaneous circulation (ROSC).
Results: Compared with N-CPR, S-CPR resulted in a significantly higher ROSC (22.2% vs. 88.9%) and 24-hour survival rate (22.2% vs. 88.9%, both P<0.05), and significant improved cardiac output (CO) and mean arterial pressure (MAP) at CPR 3, 6, 9 minutes (all P<0.01) . S-CPR also yielded lower serum values of TNF-alpha, IL-1 beta and lower expression of NF-KappaB at CPR 9 minutes and ROSC 4 hours.
Conclusion: High quality CPR not only improves survival of CA pigs, but also alleviates post-resuscitation inflammatory reaction.