Feasibility and Beneficial Effects of an Early Goal Directed Therapy After Cardiac Arrest: Evaluation by Conductance Method

Overview

Journal Sci Rep

Specialty Science

Date 2021 Mar 6

PMID 33674623

Citations 1

Authors

Ole Broch

Lars Hummitzsch

Jochen Renner

Patrick Meybohm

Martin Albrecht

Peter Rosenthal

Ann-Christine Rosenthal

Markus Steinfath

Berthold Bein

Matthias Gruenewald

Affiliations

Soon will be listed here.

Abstract

Although beneficial effects of an early goal directed therapy (EGDT) after cardiac arrest and successful return of spontaneous circulation (ROSC) have been described, clinical implementation in this period seems rather difficult. The aim of the present study was to investigate the feasibility and the impact of EGDT on myocardial damage and function after cardiac resuscitation. A translational pig model which has been carefully adapted to the clinical setting was employed. After 8 min of cardiac arrest and successful ROSC, pigs were randomized to receive either EGDT (EGDT group) or therapy by random computer-controlled hemodynamic thresholds (noEGDT group). Therapeutic algorithms included blood gas analysis, conductance catheter method, thermodilution cardiac output and transesophageal echocardiography. Twenty-one animals achieved successful ROSC of which 13 pigs survived the whole experimental period and could be included into final analysis. cTnT and LDH concentrations were lower in the EGDT group without reaching statistical significance. Comparison of lactate concentrations between 1 and 8 h after ROSC exhibited a decrease to nearly baseline levels within the EGDT group (1 h vs 8 h: 7.9 vs. 1.7 mmol/l, P < 0.01), while in the noEGDT group lactate concentrations did not significantly decrease. The EGDT group revealed a higher initial need for fluids (P < 0.05) and less epinephrine administration (P < 0.05) post ROSC. Conductance method determined significant higher values for preload recruitable stroke work, ejection fraction and maximum rate of pressure change in the ventricle for the EGDT group. EGDT after cardiac arrest is associated with a significant decrease of lactate levels to nearly baseline and is able to improve systolic myocardial function. Although the results of our study suggest that implementation of an EGDT algorithm for post cardiac arrest care seems feasible, the impact and implementation of EGDT algorithms after cardiac arrest need to be further investigated.

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References

Jones A, Shapiro N, Kilgannon J, Trzeciak S . Goal-directed hemodynamic optimization in the post-cardiac arrest syndrome: a systematic review. Resuscitation. 2008; 77(1):26-9. DOI: 10.1016/j.resuscitation.2007.10.021. View

Ameloot K, De Deyne C, Eertmans W, Ferdinande B, Dupont M, Palmers P . Early goal-directed haemodynamic optimization of cerebral oxygenation in comatose survivors after cardiac arrest: the Neuroprotect post-cardiac arrest trial. Eur Heart J. 2019; 40(22):1804-1814. DOI: 10.1093/eurheartj/ehz120. View

Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche J . Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013; 39(11):1972-80. DOI: 10.1007/s00134-013-3043-4. View

Gazmuri R, Weil M, Bisera J, Tang W, Fukui M, McKee D . Myocardial dysfunction after successful resuscitation from cardiac arrest. Crit Care Med. 1996; 24(6):992-1000. DOI: 10.1097/00003246-199606000-00020. View

Albrecht M, Meybohm P, Broch O, Zitta K, Hein M, Grasner J . Evaluation of remote ischaemic post-conditioning in a pig model of cardiac arrest: A pilot study. Resuscitation. 2015; 93:89-95. DOI: 10.1016/j.resuscitation.2015.05.019. View

Kern K, Hilwig R, Rhee K, Berg R . Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning. J Am Coll Cardiol. 1996; 28(1):232-40. DOI: 10.1016/0735-1097(96)00130-1. View

Russo J, James T, Hibbert B, Yousef A, Osborne C, Wells G . Impact of mean arterial pressure on clinical outcomes in comatose survivors of out-of-hospital cardiac arrest: Insights from the University of Ottawa Heart Institute Regional Cardiac Arrest Registry (CAPITAL-CARe). Resuscitation. 2017; 113:27-32. DOI: 10.1016/j.resuscitation.2017.01.007. View

Day N, Phu N, Bethell D, Mai N, Chau T, Hien T . The effects of dopamine and adrenaline infusions on acid-base balance and systemic haemodynamics in severe infection. Lancet. 1996; 348(9022):219-23. DOI: 10.1016/s0140-6736(96)09096-4. View

Meybohm P, Gruenewald M, Albrecht M, Muller C, Zitta K, Foesel N . Pharmacological postconditioning with sevoflurane after cardiopulmonary resuscitation reduces myocardial dysfunction. Crit Care. 2011; 15(5):R241. PMC: 3334792. DOI: 10.1186/cc10496. View

10.

Nolan J, Soar J, Cariou A, Cronberg T, Moulaert V, Deakin C . European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015; 95:202-22. DOI: 10.1016/j.resuscitation.2015.07.018. View

11.

Genbrugge C, Dens J, Meex I, Boer W, Eertmans W, Sabbe M . Regional Cerebral Oximetry During Cardiopulmonary Resuscitation: Useful or Useless?. J Emerg Med. 2015; 50(1):198-207. DOI: 10.1016/j.jemermed.2015.03.043. View

12.

Grasner J, Herlitz J, Koster R, Rosell-Ortiz F, Stamatakis L, Bossaert L . Quality management in resuscitation--towards a European cardiac arrest registry (EuReCa). Resuscitation. 2011; 82(8):989-94. DOI: 10.1016/j.resuscitation.2011.02.047. View

13.

Adrie C, Adib-Conquy M, Laurent I, Monchi M, Vinsonneau C, Fitting C . Successful cardiopulmonary resuscitation after cardiac arrest as a "sepsis-like" syndrome. Circulation. 2002; 106(5):562-8. DOI: 10.1161/01.cir.0000023891.80661.ad. View

14.

Huang L, Weil M, Tang W, Sun S, Wang J . Comparison between dobutamine and levosimendan for management of postresuscitation myocardial dysfunction. Crit Care Med. 2005; 33(3):487-91. DOI: 10.1097/01.ccm.0000156241.55872.15. View

15.

Walters E, Morawski K, Dorotta I, Ramsingh D, Lumen K, Bland D . Implementation of a post-cardiac arrest care bundle including therapeutic hypothermia and hemodynamic optimization in comatose patients with return of spontaneous circulation after out-of-hospital cardiac arrest: a feasibility study. Shock. 2010; 35(4):360-6. DOI: 10.1097/SHK.0b013e318204c106. View

16.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B . Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2002; 345(19):1368-77. DOI: 10.1056/NEJMoa010307. View

17.

Russo J, Di Santo P, Simard T, James T, Hibbert B, Couture E . Optimal mean arterial pressure in comatose survivors of out-of-hospital cardiac arrest: An analysis of area below blood pressure thresholds. Resuscitation. 2018; 128:175-180. DOI: 10.1016/j.resuscitation.2018.04.028. View

18.

DellAnna A, Sandroni C, Lamanna I, Belloni I, Donadello K, Creteur J . Prognostic implications of blood lactate concentrations after cardiac arrest: a retrospective study. Ann Intensive Care. 2017; 7(1):101. PMC: 5630540. DOI: 10.1186/s13613-017-0321-2. View

19.

Kilgannon J, Jones A, Shapiro N, Angelos M, Milcarek B, Hunter K . Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010; 303(21):2165-71. DOI: 10.1001/jama.2010.707. View

20.

Neumar R, Nolan J, Adrie C, Aibiki M, Berg R, Bottiger B . Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on.... Circulation. 2008; 118(23):2452-83. DOI: 10.1161/CIRCULATIONAHA.108.190652. View