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PubMed1991

Evidence for the 'cardiac pump theory' in cardiopulmonary resuscitation in man by transesophageal echocardiography.

There are two theories to explain the mechanism of blood flow during cardiopulmonary resuscitation: The 'Cardiac Pump Theory' and the 'Thoracic Pump Theory'. We have performed transesophageal echocardiography during the resuscitation of a patient with cardiopulmonary arrest. By this method we could study the motion of the aortic, mitral and tricuspid valves and the changes in ventricular size during cardiopulmonary resuscitation in man. We demonstrated an opening of the aortic valve during thoracic compression with simultaneous closure of the mitral and tricuspid valves. During relaxation of the chest, a rapid opening of the atrioventricular valves and closure of the aortic valve was noted. Short interruption of cardiopulmonary resuscitation to test for spontaneous heart action lead to echocontrast in all four heart chambers through stasis of blood, which resolved on continuation of cardiopulmonary resuscitation. This 'washing out' phenomenon enables visualization of blood flow through the aortic valve during compression, and through the mitral valve during relaxation. These observations favour the Cardiac Pump Theory as the predominant hemodynamic principle of blood flow during cardiopulmonary resuscitation in man.

Aged↗
PubMed1991

Nimodipine decreases resuscitability in a cardiopulmonary arrest model in the rat.

Although calcium has been implicated in ischemia-induced brain death or dysfunction, many animal studies do not show a beneficial effect of calcium-entry blockers given after resuscitation from a cardiopulmonary arrest (CPA). This may be due to the fact that treatment was started too late; we, therefore, evaluated the effect of the calcium-entry blocker nimodipine administered at the earliest feasible postischemic moment, i.e. at the start of the resuscitation attempts. In anesthetized Wistar rats, CPA was induced by an intra-cardiac injection of KCl, and maintained for 7 min by chest restriction. At the start of the resuscitation attempts, 50 rats were blindly and randomly assigned to intravenous treatment with either nimodipine (10 micrograms/kg over 2 min, followed by 1 micrograms/kg per min for 60 min; n = 25) or saline (n = 25). In the nimodipine group, significantly less rats could be resuscitated (11/25 versus 20/25) and the survival rate at the end of the 7 days evaluation period tended to be lower (5/25 versus 11/25). In the rats surviving after 7 days, there was no difference between both groups in incidence of seizures, neurological status and histological lesions in the hippocampus. It is concluded that nimodipine, in the dose tested and given during resuscitation in this rat model, has a detrimental effect on resuscitability and no beneficial effect on the neurological outcome in the surviving animals.

Animals↗
PubMed1994

ATP-MgCl2 added to resuscitation improves survival in an experimental model of hemorrhagic shock.

The administration of ATP-MgCl2 may be of benefit in the treatment of shock by improving cellular metabolic function during resuscitation. Prior studies have reported data from hemorrhage models in which heparinized shed blood is returned both during shock and in resuscitation. The purpose of this study was to test the effects of ATP-MgCl2 therapy upon blood pressure and survival in an animal model of hemorrhagic shock utilizing crystalloid (Lactated Ringer's) resuscitation. Adult male Sprague-Dawley rats (340-360 g) were bled 27 cc/kg and maintained in shock for 45 min. At the end of the shock period, animals were resuscitated with crystalloid at twice the original hemorrhage volume. A blinded three-arm study was conducted and animals were assigned to receive either Lactated Ringer's (LR) with placebo, LR with MgCl2, or LR with ATP-MgCl2. Blood pressure was monitored throughout the procedure and survival time was noted. Post-resuscitation MAP was increased in animals treated with ATP-MgCl2. ATP-MgCl2 added to resuscitation significantly improved 72-h survival over that of control (LR) animals, and animals treated with MgCl2 alone.

Adenosine Triphosphate↗
PubMed1995

Post-resuscitation disease--a new nosological entity. Its reality and significance.

Experimental and clinical investigations of patients resuscitated after cardiac arrest or terminal states, testify to the fact that in the post-resuscitation period alongside processes of recovery and compensation, a number of new pathological phenomena develop. The latter differ substantially from those caused by ischemia and hypoxia. These post-resuscitation processes involve not only the CNS, but also the entire body and may lead to severe disability and even death of the seemingly successfully revived body. The data available suggests that this post-resuscitation pathology is a new nosological entity--a post-resuscitation disease. This disease has it own specific etiology, pathogenesis, variants of the clinical course (a number of syndromes) and the system of treatment and rehabilitation. In view of the ever wider use of resuscitation in clinical practice, it is expedient to organize an all-round study of this nosological entity, the optimum systems of its treatment, and to include this entity into International Classification of Diseases of WHO.

Central Nervous System Diseases↗
PubMed1985

Rapid change in pulmonary vascular hemodynamics with pulmonary edema during cardiopulmonary resuscitation.

Previous studies have shown that pulmonary edema occurs in half of all pre-hospital cardiac arrest victims who cannot be successfully resuscitated and is a major cause of hypoxemia and poor lung compliance during resuscitation. Pulmonary vascular hypertension and elevation of pulmonary capillary wedge pressure have been observed during cardiac resuscitation in humans. To further define the time course of the pulmonary hemodynamic changes, pulmonary artery diastolic pressure (PAd) was measured on a computerized trend recorder prior to, during, and immediately after arrest in three adult patients. Prior to arrest, PADP was 20.9 +/- 3.1 mm Hg. The PADP rose in all three patients by an average of 30.6% after 5-10 minutes and 71.3% after 10-15 minutes of CPR. Peak PADP reached 35.8 +/- 5.1 mm Hg (difference from pre-arrest level significant, P less than 0.001). In both patients who were resuscitated successfully, the PADP returned to baseline within 5 minutes of effective spontaneous circulation. The finding that such hemodynamic changes occur rapidly during resuscitation and can reverse quickly with resumption of effective spontaneous circulation is consistent with the time course for the early development of pulmonary edema. Development of pulmonary edema many hours following successful resuscitation likely involves other mechanisms.

Blood Pressure↗
PubMed1985

Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests.

Recent studies evaluating interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) have demonstrated a significant increase in cardiac output, mean arterial pressure, and cerebral perfusion, as compared with standard CPR. A clinical evaluation of IAC-CPR effectiveness on resuscitation outcome has not been reported. A prospective randomized study comparing IAC-CRP with standard CPR for resuscitation of prehospital cardiopulmonary arrest was undertaken using the Milwaukee County Paramedic System. The patients were randomized following endotracheal intubation into IAC-CPR and standard CPR groups. Since October 1983, 291 patients have qualified for the study group. Of these, 146 patients had standard CPR, and 45 (31%) were successfully resuscitated. Of the 145 patients treated with IAC-CPR, 40 (28%) were successfully resuscitated. Chi-square analysis reveals no significant difference between these groups. To determine whether abdominal compression increases regurgitation, the frequency of emesis before and after intubation was analyzed. No significant difference was found between the IAC-CPR and standard CPR groups. Thus, IAC-CPR applied by paramedics in the field to patients following intubation does not improve cardiac resuscitation rates.

Abdomen↗
PubMed1995

Effect of age on prehospital cardiac resuscitation outcome.

To compare resuscitation outcomes in elderly and younger prehospital cardiac arrest victims, we used a retrospective case series over 5 years in rural advanced life support (ALS) units and a University hospital base station. Participants included 563 adult field resuscitations. Excluded were patients with noncardiac etiologies, those less than 30 years old, and those with unknown initial rhythms. Patients were grouped by age. Return of spontaneous circulation (ROSC) and survival to hospital discharge were compared by Yates' chi-square test. ALS treatment of cardiac arrest was by regional protocols and on-line physician direction. Sixty percent (320/532) of patients were over 65 years old. The proportion with initial rhythm ventricular fibrillation (VF) was 50% in the elderly and 48% in younger patients. ROSC was achieved in 18% of elderly and 16% of younger patients; survival was 4% among the elderly and 5% for younger patients. The oldest survivor was 87 years old. Most survivors were discharged, in good Cerebral Performance Categories. There was no difference in outcome by age group when initial cardiac rhythm was considered. Early cardiopulmonary resuscitation (CPR) and ALS and initial rhythm VF were associated with the best resuscitation success. Age has less effect on resuscitation success than other well-known factors such as early CPR and ALS. Advanced age alone should probably not deter resuscitation attempts.

Adult↗
PubMed1995

Effect of supplemental perfluorocarbon administration on hypotensive resuscitation of severe uncontrolled hemorrhage.

Recent animal studies of acute hemorrhage in the presence of a vascular injury have demonstrated improved survival and decreased hemorrhage volume with hypotensive resuscitation, but this has occurred at the expense of tissue perfusion. It was hypothesized that addition of an oxygen-carrying perfusate would improve tissue oxygen delivery during hypotensive resuscitation. Hypotensive resuscitation of severe uncontrolled hemorrhage was compared with and without supplementation with Oxygent HT, an emulsion of perflubron (perfluorooctylbromide; PFOB; Alliance Pharmaceutical Corporation, San Diego, CA), an oxygen-carrying perfusate. Fifteen swine (15 to 22 kg) with 4-mm aortic tears were bled to a pulse pressure of 5 mm Hg and then resuscitated (estimated blood loss, 40 to 50 mL/kg). All animals were resuscitated with normal saline (6 mL/kg/min) infused as needed to maintain a mean arterial pressure of 40 mm Hg. One group (PFC) of animals also received an infusion of 6 mL/kg perfluorooctylbromide emulsion. Another group served as controls and received an equal volume of placebo (normal saline). Animals were observed for 120 minutes or until death. Data were compared using repeated measures analysis of variance (ANOVA) the Student's t test, and Fisher's exact. A P value < .05 was considered significant. Two-hour mortality rates were 12.5% and 43% for PFC-treated animals and controls, respectively (P > .05; 95% confidence interval [95% CI] for this difference in mortality is -13% to 74%). Oxygen content and delivery were significantly greater in the treatment group. In conclusion, administration of an oxygen-carrying perfusate significantly improves oxygen delivery in hypotensive crystalloid resuscitation of severe uncontrolled hemorrhage.

Animals↗
PubMed2005

Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients?

This study evaluated the ability of cardiac sonography performed by emergency physicians to predict resuscitation outcomes of cardiac arrest patients. A convenience sample of cardiac arrest patients prospectively underwent bedside cardiac sonography at 4 emergency medicine residency-affiliated EDs as part of the Sonography Outcomes Assessment Program. Cardiac arrest patients in pulseless electrical activity (PEA) and asystole underwent transthoracic cardiac ultrasound B-mode examinations during their resuscitations to assess for the presence or absence of cardiac kinetic activity. Several end points were analyzed as potential predictors of resuscitations: presenting cardiac rhythms, the presence of sonographically detected cardiac activity, prehospital resuscitation time intervals, and ED resuscitation time intervals. Of 70 enrolled subjects, 36 were in asystole and 34 in PEA. Patients presenting without evidence of cardiac kinetic activity did not have return of spontaneous circulation (ROSC) regardless of their cardiac rhythm, asystole, or PEA. Of the 34 subjects presenting with PEA, 11 had sonographic evidence of cardiac kinetic activity, 8 had ROSC with subsequent admission to the hospital, and 1 had survived to hospital discharge with scores of 1 on the Glasgow-Pittsburgh Cerebral Performance scale and 1 in the Overall Performance category. The presence of sonographically identified cardiac kinetic motion was associated with ROSC. Time interval durations of cardiac resuscitative efforts in the prehospital environment and in the ED were not accurate predictors of ROSC for this cohort. Cardiac kinetic activity, or lack thereof, identified by transthoracic B-mode ultrasound may aid physicians' decision making regarding the care of cardiac arrest patients with PEA or asystole.

Adolescent↗
PubMed2005

Narratives about resuscitation--family members differ about presence.

BACKGROUND: Healthcare professionals disagree about admitting family members into the resuscitation room. AIM: The aim of this study was to illuminate family members' experiences and views about being present in the resuscitation room with a relative requiring resuscitation. RESULTS: Seventeen family members were interviewed. Their narratives were analysed using content analysis. The main theme was interpreted as family members being "afraid of disturbing the resuscitation efforts, meaning that the most important person for them was the patient". Three groups of persons were in focus: patients, family members, and healthcare professionals. The theme related to the patient was "to be caring for the good of oneself and others" describing what family members believed the patient would want and what they themselves would have wanted if in the same situation. The themes related to family members were "to be dependent on the interplay between trusting oneself and advocating the patient and to be sensitive to one's own emotions and to be reasonable". The theme related to healthcare professionals was "to submit to or ignore the guidance of the healthcare professionals". CONCLUSION: Family members differ about their presence in the resuscitation room. Omnipresent in the narratives was being afraid of disturbing the resuscitation efforts.

Adult↗
PubMedDate not supplied

Barriers to and facilitators for newborn resuscitation in Malawi, Africa.

Newborn resuscitation is a key component of efforts to reduce neonatal morbidity and mortality. This article reports the findings of focus groups conducted to explore the barriers and facilitators present for obstetric nurse providers in a central urban hospital in Malawi regarding the training and provision of neonatal resuscitation. All obstetric nurse providers in this setting participated in focus groups; these groups identified 4 themes: 1) confidence in their skills in assessing newborns and recognizing the need for resuscitation, 2) a lack of resources, 3) facilitators who would enable them to introduce resuscitation, and 4) solutions to the current problems. Resource shortages and barriers to providing care included availability of staff, equipment, and supplies; labor ward geography; ethical dilemmas; and the lack of standard protocols regarding newborn resuscitation. Facilitators were professional experience and the critical load of deliveries performed. Solutions to barriers included small resource additions as well as long-term policy changes. With standard policy and protocols, experienced, confident nurses could overcome the barriers to providing newborn resuscitation. This group identified ways to change systems to decrease infant mortality, thereby improving the health and quality of life of women receiving care in Malawi.

Attitude of Health Personnel↗
PubMed2004

Improving the rate of return of spontaneous circulation for out-of-hospital cardiac arrests with a formal, structured emergency resuscitation team.

OBJECTIVE: To assess the impact of a formal, structured resuscitation team in the emergency department (ED) on the success rate of cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. METHODS: This is a "three-phase" (organized, transitional, and re-organized), prospective study in which medical records of all OHCA patients who needed resuscitation in the ED during the three 6-month periods were reviewed and data were coded in out-of-hospital Utstein style formats. An organized resuscitation team existed in the organized and re-organized phases but not in the transitional phase. The study population consisted of adult patients with non-traumatic cardiac arrest (>18 years of age). RESULTS: The rates of return of spontaneous circulation (ROSC) were 51.3% for the organized phase, 31.0% for the transitional phase, and 53.1% for the re-organized phase ( P=0.013 ). The rates of ROSC from pulseless electrical activity (PEA)/asystole were significantly higher in periods with organized and re-organized teams ( P=0.007 ). The rates of ROSC for the ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) sub-groups were not significantly different in all three periods ( P=0.406 ). The chance of survival-to-discharge was 9.2% in the organized period, 11.2% in the transitional period, and 15.6% in the re-organized period ( P=0.496 ). The existence of a formal, structured emergency resuscitation team in the ED (odds ratio: 2.56, 95% confidence interval: 1.35-4.80) and witness at the scene (odds ratio: 2.45, 95% confidence interval: 1.34-4.45) were the only independent predictors of successful ROSC of OHCA patients by multiple logistic regression analysis. CONCLUSION: The establishment of a formal and structured emergency resuscitation team in the ED is associated with an increased rate of ROSC for OHCA patients.

Ambulances↗
PubMed2004

A strategy to optimise the performance of the mouth-to-bag resuscitator using small tidal volumes: effects on lung and gastric ventilation in a bench model of an unprotected airway.

When ventilating an unintubated patient with a standard adult self-inflating bag, high peak inspiratory flow rates may result in high peak airway pressures with subsequent stomach inflation. In a previous study we have tested a newly developed mouth-to-bag-resuscitator (max. volume, 1500 ml) that limits peak inspiratory flow, but the possible advantages were masked by excessive tidal volumes. The mouth-to-bag-resuscitator requires blowing up a balloon inside the self-inflating bag that subsequently displaces air, which then flows into the patient's airway. Due to this mechanism, gas flow and peak airway pressures are reduced during inspiration when compared with a standard bag-valve-mask-device. In addition, the device allows the rescuer to use two hands instead of one to seal the mask on the patient's face. The purpose of the present study was to assess the effects of the mouth-to-bag-resuscitator, which was modified to produce a maximum tidal volume of 500 ml, compared with a paediatric self-inflating bag (max. volume, 380 ml), and a standard adult self-inflating bag (max. volume, 1500 ml) in an established bench model simulating an unintubated patient with respiratory arrest. The bench model consisted of a face mask, manikin head, training lung (lung compliance, 100 ml/0.098 kPa (100ml/cm H2O); airway resistance, 0.39 kPa/(l s) (4 cm H2O/(l s)), and a valve simulating lower oesophageal sphincter pressure, 1.47 kPa (15 cm H2O). Twenty critical care nurses volunteered for the study and ventilated the manikin for 1 min with a respiratory rate of 20 min(-1) with each ventilation device in random order. The mouth-to-bag-resuscitator versus paediatric self-inflating bag resulted in significantly (P < 0.05) higher lung tidal volumes (302 +/- 41 ml versus 233 +/- 22 ml), and peak airway pressure (10 +/- 1 cm H2O versus 9 +/- 1 cm H2O), but comparable inspiratory time fraction (28 +/- 5% versus 27 +/- 5%, Ti/Ttot), peak inspiratory flow rate (0.6 +/- .01 l/s versus 0.6 +/- 0.2 l/s), and stomach inflation (149 +/- 495 ml/min versus 128 +/- 278 ml/min). In comparison with the adult self-inflating bag, there was significantly (P < 0.05) less gastric inflation (3943 +/- 4896 ml/min versus 149 +/- 495 ml/min versus 128 +/- 278 ml/min, respectively) with both devices, but the standard adult self-inflating bag had significantly higher lung tidal volumes (566 +/- 77 ml), peak airway pressure (13 +/- 1 cm H2O), and peak inspiratory flow rate (0.8 +/- 0.11 l/s). In conclusion, comparing the mouth-to-bag-resuscitator with small tidal volumes versus the paediatric self-inflating-bag during simulated ventilation of an unintubated patient in respiratory arrest resulted in comparable marginal stomach inflation, but significantly reduced the likelihood of gastric inflation compared to the adult self-inflating-bag. Lung tidal volumes were improved from approximately 250 ml with the paediatric self-inflating-bag to approximately 300 ml with the mouth-to-bag-resuscitator.

Adult↗
PubMed2004

Optimal dosing of dobutamine for treating post-resuscitation left ventricular dysfunction.

OBJECTIVES: This study was designed to determine the optimal dose of dobutamine in the treatment of post-resuscitation left ventricular dysfunction. BACKGROUND: Global left ventricular dysfunction following successful resuscitation from prolonged, ventricular fibrillation cardiac arrest, negatively impacts long-term survival. Dobutamine can overcome this global myocardial stunning. Previous data indicate a dose of 10 mcg/kgmin improves systolic and diastolic function, but markedly increases the heart rate. METHODS: Twenty swine (24 +/- 0.4 kg) were randomized to one of four doses (0, 2, 5, and 7.5 mcg/kgmin) of dobutamine for the treatment of post-resuscitation myocardial dysfunction following 12.5 min of untreated ventricular fibrillation cardiac arrest. Cardiac function was measured at pre-arrest baseline and serially for 6 h post-resuscitation. Left ventricular function was evaluated by contrast ventriculograms, left ventricular pressures, +dP/dt, Tau, -dP/dt, and cardiac output. Myocardial oxygen consumption and myocardial blood flow were measured to assess the functional significance of any dobutamine-mediated heart rate responses. RESULTS: Left ventricular dysfunction was evident at 25 min and peaked 4 h post-resuscitation. Significant (P < 0.05) improvements in ventricular systolic (EF, CO) and diastolic (LVEDP, Tau) function were evident within minutes of dobutamine initiation and persisted at 6h for the 5 and 7.5 mcg/kgmin groups. Tachycardia manifested with all dobutamine doses, but only affected myocardial oxygen consumption significantly (P < 0.05) at the highest dose (7.5 mcg/kgmin). CONCLUSIONS: Dobutamine at 5 mcg/kgmin appears optimal for restoring systolic and diastolic function post-resuscitation without adversely affecting myocardial oxygen consumption.

Analysis of Variance↗
PubMed2005

A survey of resuscitation training needs of senior anaesthetists.

Resuscitation skills are a fundamental part of anaesthetic practice. Anaesthetists are involved in performing resuscitation and training of other staff in resuscitation techniques. However, very few senior anaesthetists attend the Resuscitation Council (UK)/European Resuscitation Council [RC (UK)/ERC] advanced life support (ALS) course. We have surveyed the views of consultant anaesthetists in one region of the UK. The results show that although they are involved in training, very few attend cardiac arrests. Most have not, and will not, attend the ALS course but would prefer shorter regular resuscitation updates, especially in those skills that they no longer use.

Anesthesiology↗
PubMed2005

Factors influencing survival after in-hospital cardiopulmonary resuscitation.

INTRODUCTION: During recent years, in-hospital cardiopulmonary resuscitation (CPR) management has received much attention. However, the rate of survival after in-hospital resuscitation in Iran hospitals is not known. Therefore, a study was designed to evaluate the outcome of in-hospital cardiopulmonary resuscitation (CPR) in the city of Kashan, Iran, during a 6-month period during 2002. MATERIAL AND METHODS: A prospective descriptive study was conducted on all cases of in-hospital cardiopulmonary resuscitation. Necessary data including the age and sex of patients, shift, time from cardiac arrest until initiating of CPR, time from cardiac arrest until defibrillation, duration and result of CPR, were recorded in a checklist. Descriptive statistics presented. RESULTS: A total of 206 cases of CPR were attempted during the research period. The study population consisted of 59.2% males and 40.8% females. The survival rate was similar for both sexes. Short-term survival was observed in 19.9% of cases and only 5.3% survived to discharge. The key predictors of survival to hospital discharge were CPR duration, time of cardiac arrest, time from cardiac arrest to initiation of CPR, and defibrillation within the first few minutes of cardiac arrest. CONCLUSIONS: Our study showed that it needs more attention to be paid to cardiopulmonary resuscitation management in Iran's hospitals. The results of this study could be an important first step toward a national study on the survival after cardiopulmonary resuscitation to provide accurate data on our performance with regards to the chain of survival.

Adolescent↗
PubMed2005

Influence of resuscitation volume on blood cells TNF production in a murine model of haemorrhage.

The influence of haemorrhage and resuscitation on Tumour Necrosis Factor (TNF) production by whole blood cultures under endotoxin (Escherichia coli LPS) stimulation was investigated in male BALB/c mice. Haemorrhagic shock was induced by removing 0.026 +/- 0.003 mL of blood/g via a cardiac puncture, resulting in a 50% decrease in arterial pressure and a metabolic adidosis. Animals were resuscitated successfully (normotensive) despite a residual base deficit and hyperlactatemia, 60 min after the haemorrhage by the restitution of shed blood volume (SBV) with or without an additional volume of crystalloid (Lactated Ringer's solution) equal to 50, 100 (isovolumetric resuscitation) or 200% of SBV. Pulmonary failure (hypoxia-hypercarbia) and myocardial injury (troponin I release) was observed in this last group. TNF production by whole blood cultures stimulated ex vivo by LPS was estimated 60 min after the end of resuscitation. Haemorrhage resulted in a 48-60% decrease in TNF production. This decrease so-called 'leukocyte deactivation' was not modified by the restitution of SBV with or without crystalloid except for isovolumetric resuscitation which resulted in the cytokine level returning to control in the absence of clear cardiopulmonary dysfunction. In the present murine model of haemorrhage, modifying resuscitation volume influences in vitro TNF production in whole blood cultures challenged by LPS.

Anesthetics, Inhalation↗
PubMed2006

Resuscitation of severe but brief haemorrhagic shock with PFC in rabbits restores skeletal muscle oxygen delivery and does not alter skeletal muscle metabolism.

Studies have demonstrated that perfluorocarbon (PFC) emulsions associated with hyperoxia improved whole body oxygen delivery during resuscitation of acute haemorrhagic shock (HS). Nevertheless the microcirculatory effects of PFC and the potential deleterious effects of hyperoxic reperfusion are still of concern. We investigated (i) the ability of a newly formulated, small sized and highly stable PFC emulsion to increase skeletal muscle oxygen delivery and (ii) the effect of hyperoxic reperfusion on skeletal muscle metabolism after a brief period of ischaemia using an original, microdialysis-based method that allowed simultaneous measurement tissue oxygen pressure (PtiO2) and interstitial lactate and pyruvate. These measurements were carried out in anaesthetised and ventilated (FiO2 = 1) rabbits subjected to acute HS (50% of blood volume withdrawal) and either resuscitated with a PFC emulsion diluted with a 5% albumin solution (16.2 g PFC per kg body weight) (n = 10) or with a modified fluid gelatin solution (Gelofusine) (n = 10). We found no difference between the two groups for the haemodynamic and haematological variables (except for the venous oxygen partial pressure). However, a significant difference was observed in the slope of the regression linear relationship exhibited between the mean arterial pressure (MAP) and the PtiO2, PFC group showing a much steeper slope than Gelofusine group. In addition, PtiO2 values increased linearly with decreasing haematocrit (Hct) values in PFC-resuscitated animals and decreased linearly with decreasing Hct values in Gelofusine-resuscitated animals. There were no differences between the two groups concerning the blood and interstitial lactate/pyruvate ratios suggesting no deleterious effect of hyperoxic resuscitation in skeletal muscle. In conclusion these results suggest that resuscitation of severe, but brief, HS with PFC increased skeletal muscle oxygen delivery without measurable deleterious effects.

Animals↗