Impact of intravenous fluid administration on cardiac output and oxygenation during cardiopulmonary resuscitation

Jennifer Lutz; Yosef Levenbrown; Md Jobayer Hossain; Anne Hesek; Kelly E Massa; James P Keith; Thomas H Shaffer

doi:10.1186/s40635-023-00497-4

Impact of intravenous fluid administration on cardiac output and oxygenation during cardiopulmonary resuscitation

Intensive Care Med Exp. 2023 Mar 24;11(1):13. doi: 10.1186/s40635-023-00497-4.

Authors

Jennifer Lutz^{1

2}, Yosef Levenbrown^{3

4}, Md Jobayer Hossain^{5

6}, Anne Hesek⁵, Kelly E Massa⁷, James P Keith⁷, Thomas H Shaffer^{2

8

9}

Affiliations

¹ Division of Pediatric Critical Care, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
² Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA.
³ Division of Pediatric Critical Care, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA. yoseflevenbrown@gmail.com.
⁴ Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA, USA. yoseflevenbrown@gmail.com.
⁵ Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA.
⁶ Department of Applied Economics and Statistics, University of Delaware, Newark, DE, USA.
⁷ Department of Respiratory Care, Nemours Children's Health, Wilmington, DE, USA.
⁸ Nemours Biomedical Research/Research Lung Center, Nemours Children's Health, Wilmington, DE, USA.
⁹ Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.

Abstract

Background: The effect of intravenous fluid (IVF) administration during cardiopulmonary resuscitation (CPR) is an unexplored factor that may improve cardiac output (CO) during CPR. The aim of this study was to determine the effect of IVF administration on CO and oxygenation during CPR.

Methods: This experimental animal study was performed in a critical care animal laboratory. Twenty-two Landrace-Yorkshire female piglets weighing 27-37 kg were anesthetized, intubated, and placed on positive pressure ventilation. Irreversible cardiac arrest was induced with bupivacaine. CPR was performed with a LUCAS 3 mechanical compression device. Pigs were randomized into IVF or no-IVF groups. Pigs in the IVF group were given 20 mL/kg of Plasma-Lyte (Baxter International, Deerfield, IL USA), infused from 15 to 35 min of CPR. CPR was maintained for 50 min with serial measurements of CO obtained using ultrasound dilution technology and partial pressure of oxygen (PaO₂).

Results: A mixed-effects repeated measures analysis of variance was used to compare within-group, and between-group mean changes in CO and PaO₂ over time. CO and PaO₂ for the piglets were measured at 10-min intervals during the 50 min of CPR. CO was greater in the IVF compared with the control group at all time points during and after the infusion of the IVF. Mean PaO₂ decreased with time; however, at no time was there a significant difference in PaO₂ between the IVF and control groups.

Conclusions: Administration of IVF during CPR resulted in a significant increase in CO during CPR both during and after the IVF infusion. There was no statistically significant decrease in PaO₂ between the IVF and control groups.

Keywords: Advanced cardiac life support; Basic cardiac life support; Cardiac arrest; Cardiac output; Out-of-hospital cardiac arrest.

Grants and funding

P30GM114736/NIH COBRA