scholarly journals Comparative study between fluidless resuscitation with permissive hypotension using the impedance threshold device versus aggressive fluid resuscitation with Ringer lactate in a swine model of hemorrhagic shock

Critical Care ◽  
2015 ◽  
Vol 19 (Suppl 1) ◽  
pp. P174
Author(s):  
C Pantazopoulos ◽  
I Floros ◽  
N Archontoulis ◽  
D Xanthis ◽  
D Barouxis ◽  
...  
Keyword(s):  
Comparative Study ◽  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Swine Model ◽  
Ringer Lactate ◽  
Permissive Hypotension ◽  
Aggressive Fluid Resuscitation ◽  
Threshold Device ◽  
Impedance Threshold Device

Influence of Hemorrhagic Shock and Subsequent Fluid Resuscitation on the Electroencephalographic Effect of Isoflurane in a Swine Model

2005 ◽  
Vol 103 (6) ◽  
pp. 1189-1194
Author(s):  
Tadayoshi Kurita ◽  
Koji Morita ◽  
Kazushige Fukuda ◽  
Masahiro Uraoka ◽  
Kotaro Takata ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Swine Model

Abstract 17: Controlled Progressive Elevation Maximizes Cerebral Perfusion Pressure During Head up CPR in a Swine Model of Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Johanna C Moore ◽  
Bayert Salverda ◽  
Michael Lick ◽  
Carolina Rojas-Salvador ◽  
Guillaume Debaty ◽  
...  
Keyword(s):  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Coronary Perfusion Pressure ◽  
Swine Model ◽  
Coronary Perfusion ◽  
Sequence Effect ◽  
Optimal Angle ◽  
Threshold Device ◽  
Acd Cpr ◽  
Impedance Threshold Device

Background: Elevation of the head and thorax (HUP) during cardiopulmonary resuscitation (CPR) has been shown to result in a doubling of brain blood flow with higher Cerebral Perfusion Pressures (CerPP) after prolonged active compression-decompression (ACD) CPR with an impedance threshold device (ITD). However, the optimal angle and speed of elevation are unknown. Methods: In study A, in an anesthetized female 40 kg pig model of untreated ventricular fibrillation for 8 min, different HUP angles were assessed (20°, 30°, 40°) in a randomized manner each over a 5-minute periods of ACD+ITD CPR. Based upon study A results, study B was performed, wherein animals were randomized to the two following sequences: 20°, 30°, 40° or 40°, 30°, 20° using the same protocol. The primary endpoint was mean ± SD CerPP (mmHg) for both studies. Results: In study A, 18 pigs were studied. Overall, there was no optimal HUP angle: CerPP was 36 ± 19 for 20°, 42 ± 21 for 30°, and 44 ± 27 for 40° (p = 0.57). However, CerPPs were higher if 40 o HUP was performed during the last 5 minutes of the resuscitation (77 ± 17), versus 20 o HUP and 30 o HUP (44± 18, p = 0.003), suggestive of a sequence effect. To test this hypothesis, study B then enrolled additional animals to compare two elevation sequences 20°, 30°, 40° (n = 6) or 40°, 30°, 20° (n = 5). At 15 min of CPR, the CerPP for 20°, 30°, 40° group was 60 ± 17 and for 40°, 30°, 20° the CerPP was 23 ± 19 (p = 0.01). CerPPs were higher for the 20°, 30°, 40° group throughout the resuscitation (Figure 1). Coronary perfusion pressure was also significantly higher in the 20°, 30°, 40° group (50 ± 17 mmHg versus 22 ± 16 mmHg, p = 0.036) Conclusions: There did not appear to be an optimal HUP angle during ACD+ITD CPR. By contrast, there was an optimal HUP sequence (20,30,40) that resulted in significantly higher CerPP, suggesting controlled progressive elevation is important when performing HUP CPR as compared to an absolute immediate elevation of the head and thorax.

Abstract 139: Impedance Threshold Device and Active Decompression Improve Hemodynamics in a Swine Model of Prolonged CPR

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Joshua W Lampe ◽  
Yin Tai ◽  
Anja K Metzger ◽  
Christopher L Kaufman ◽  
Lance B Becker
Keyword(s):  
Blood Flow ◽  
Chest Compression ◽  
Zero Point ◽  
Swine Model ◽  
Carotid Blood Flow ◽  
Blood Flows ◽  
Lift Height ◽  
Threshold Device ◽  
Acd Cpr ◽  
Impedance Threshold Device

Introduction: Cardiopulmonary resuscitation with the impedance threshold device and active decompression (ITD-ACD CPR) has been shown to improve chest compression generated blood flow relative to standard chest compression. Using our high-fidelity swine model of cardiac arrest treated with prolonged mechanical chest compression (MCC) we studied the effect of different lift heights (amount of lift above the natural zero point of the sternum) during active decompression. Methods: CPR was performed on six domestic swine (~30 kg) using standard physiological monitoring. Flow was measured in the abdominal aorta, inferior vena cava (IVC), right common carotid and external jugular, and left femoral artery. Ventricular fibrillation (VF) was electrically induced. MCC were started after ten minutes of VF. Four MCC waveforms were used: Standard CPR (2”, 100 CPM), and ITD-ACD CPR (2”, 80 CPM) with 0.5”, 1.0”, and 1.5” lift past the zero point. MCC waveforms were changed every 2 min in a crossover design and delivered for 56 minutes. Data were analyzed in CPR cycles which included four epochs of CPR, one of each waveform, constituting 8 minutes of compressions. Results: Lift height had a significant (p<0.05) effect on carotid and jugular blood flow. Lift heights of 1.0 and 1.5” generated significantly more carotid blood flow in all 7 CPR cycles. A lift height of 1.5” generated significantly more jugular blood flow over all 7 CPR cycles. The interaction between duration of CPR and Jugular blood flow previously observed using this animal model was not observed. Carotid and jugular blood flow as a function of waveform and CPR cycle are shown in the figure. Conclusions: ITD-ACD CPR improved carotid and jugular blood flows, suggestive of improved cerebral perfusion. A lift height of 1.5” was required for significant improvement of jugular blood flows, while ITD-ACD CPR provided significantly better carotid blood flow than standard CPR at all lift heights.

Abstract 2840: An Impedance Threshold Device Improves 24 Hour Survival in a Spontaneously Breathing Pediatric Porcine Model of Hemorrhagic Shock

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Anja Metzger ◽  
Brad Marino ◽  
Tim Matsuura ◽  
Carly Alexander ◽  
Margot Herman ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Sham Group ◽  
Survival Rates ◽  
Term Survival ◽  
Kaplan Meier ◽  
Threshold Device ◽  
Short And Long Term ◽  
Spontaneously Breathing ◽  
Impedance Threshold Device

Introduction: Traumatic injury and hypovolemic shock are leading causes of death in children worldwide. We previously demonstrated that augmentation of negative intrathoracic pressure generated by spontaneously breathing through an impedance threshold device (ITD) improves blood pressure and cardiac output in a pediatric porcine model of hemorrhagic shock. However, the optimal method to restore intravascular volume, prevent secondary organ damage, and prevent progression of reversible shock to irreversible circulatory collapse after severe blood loss in children is not known. Hypothesis: Breathing through an ITD for 90 min prior to fluid resuscitation will safely increase short and long-term survival rates. Methods: Seventeen spontaneously breathing female piglets (12.4 ± 0.1 kg), anesthetized with propofol, were subjected to a 40% bleed and randomized in a prospective, blinded manner to either a sham or active ITD (cracking pressure of -7 cmH2O, Advanced Circulatory Systems, Minneapolis, MN) for 90 min. Shed blood was then reinfused. Work of breathing (WOB), 90 minute and 24 hour survival were evaluated. Survival analysis was performed using the Wilcoxon Rank Sum Test, Fischer’s Exact Test, and Kaplan-Meier Methods. Results: Baseline and post-bleed heart rate, blood pressure, lactate levels, and arterial blood gas parameters were similar between groups. Piglets treated with the active ITD had significantly improved survival compared to the piglets treated with the sham ITD at 90 min (8/9 vs. 3/8, p=0.04). At 24 hours, Kaplan-Meier curve analysis revealed improved survival with the active ITD (6/9 vs. 2/8, p=0.04). The 3 animals in the active ITD group that did not survive died at a median time of 280 minutes (82–580), and the 6 animals in the sham group that did not survive, died at a median time of 69 minutes (24 –101) after bleed (p=0.11). The WOB at 45 min (J/L) was 73% higher in the active ITD group than the sham group (1.18 ± 0.07 vs. 0.68 ± 0.07, p= 0.001). The piglets safely tolerated the active ITD therapy. Conclusion: In this spontaneously breathing, anesthetized piglet model of hemorrhagic shock, treatment with an active ITD for 90 min without supplemental fluid resuscitation significantly improved short and long-term survival rates.

Hemodilution as a result of aggressive fluid resuscitation aggravates coagulopathy in a rat model of uncontrolled hemorrhagic shock

2013 ◽  
Vol 74 (3) ◽  
pp. 808-812 ◽  
Author(s):  
Kouichirou Nishi ◽  
Akira Takasu ◽  
Hirotoshi Shinozaki ◽  
Yorihiro Yamamoto ◽  
Toshihisa Sakamoto
Keyword(s):  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Rat Model ◽  
Aggressive Fluid Resuscitation

scholarly journals Comparison of Permissive Hypotension vs. Conventional Resuscitation Strategies in Adult Trauma Patients with Hemorrhagic Shock: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

2021 ◽  
Author(s):  
Yang Zhang ◽  
Yaping Ding ◽  
Dongbin Zheng ◽  
Xusheng Huang ◽  
Junhui Zhang ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Randomized Controlled Trials ◽  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Meta Analysis ◽  
Intervention Group ◽  
Systolic Pressure ◽  
Controlled Trials ◽  
Permissive Hypotension ◽  
Randomized Controlled

Abstract BackgroundThere is still an ongoing battle against the Permissive Hypotension (PH) through Conventional Resuscitation Strategies (CR). Active fluid resuscitation in patients with traumatic shock can bring many problems, as it is known that standard high-volume resuscitation can exacerbate the lethal triad of acidemia, hypothermia, and coagulopathy. As a part of damage control resuscitation strategy, it can reduce mortality and shorten hospital stay, compared with the use of standard liquids. Moreover, its application is gradually receiving wider attention (1) . This review evaluated the effectiveness and safety of permissive hypotension resuscitation in adult patients with traumatic hemorrhagic shock.MethodsThe systematic review and meta-analysis were conducted according to PRISMA guidelines. We searched PubMed, EMBASE and Cochrane databases for randomized controlled trials (RCTs) from the beginning to March 2021 to compare the therapeutic effects of controlled fluid resuscitation and conventional fluid resuscitation on patients with traumatic hemorrhagic shock. Two reviewers independently conducted screening, data extraction and bias assessment. Data analysis was performed using Cochrane Collaboration Software Revman 5.2. The primary outcome was 30-day or in-hospital mortality. Secondary outcomes included blood routine index, coagulation function, resuscitation fluid use, complications, and length of hospital stay. Pooling was performed with a random-effects model.Results8 randomized controlled trials were screened out of 898 studies and 1593 patients were evaluated. The target blood pressure of the intervention group ranged from 50-90 mmHg in systolic pressure or mean arterial pressure ≥ 50 mmHg, while that of the control group was 65-110 mmHg systolic pressure or mean arterial pressure ≥ 60 mmHg. Only patients with penetrating injuries were evaluated in two studies, while the remaining six included blunt injuries. A statistically significant reduction in mortality was observed in the intervention group (RR = 0.70; 95%CI= 0.58-0.84; P < 0.05). Small heterogeneity was observed in the included articles (χ2 = 8.9; P = 0.18; I2 = 33%). The loss of platelet (PLT), hemoglobin (Hb) and body fluid was properly protected, the amount of resuscitation fluid was reduced, and the incidence of some adverse events was effectively reduced. There was no significant difference in coagulation time and hospital stay between the two groups.ConclusionsThis meta-analysis reveals the survival benefits of hypotension resuscitation in patients with traumatic hemorrhagic shock. The significant advantage is to promote the recovery of patients' physical function and reduce the incidence of treatment-related complications such as acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and multiple organ dysfunction syndrome (MODS), which reduces the mortality. Convincing evidences are provided based on these results, but larger, multicenter, randomized trials are needed to confirm the findings.

Use of the impedance threshold device improves survival rate and neurological outcome in a swine model of asphyxial cardiac arrest*

2012 ◽  
Vol 40 (3) ◽  
pp. 861-868 ◽  
Author(s):  
Ioannis N. Pantazopoulos ◽  
Theodoros T. Xanthos ◽  
Ioannis Vlachos ◽  
Georgios Troupis ◽  
Evangelos Kotsiomitis ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Neurological Outcome ◽  
Swine Model ◽  
Threshold Device ◽  
Impedance Threshold Device ◽  
Asphyxial Cardiac Arrest
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