Perfluorocarbon induced intra-arrest hypothermia does not improve survival in a swine model of asphyxial cardiac arrest.

Abstract

Pulseless electrical activity is an important cause of cardiac arrest. Our purpose was to determine if induction of hypothermia with a cold perfluorocarbon-based total liquid ventilation (TLV) system would improve resuscitation success in a swine model of asphyxial cardiac arrest/PEA. Twenty swine were randomly assigned to control (C, no ventilation, n=11) or TLV with pre-cooled PFC (n=9) groups. Asphyxia was induced by insertion of a stopper into the endotracheal tube, and continued in both groups until loss of aortic pulsations (LOAP) was reached, defined as a pulse pressure less than 2mmHg. The TLV animals underwent asphyxial arrest for an additional 2min after LOAP, followed by 3min of hypothermia, prior to starting CPR. The C animals underwent 5min of asphyxia beyond LOAP. Both groups then underwent CPR for at least 10min. The endpoint was the resumption of spontaneous circulation maintained for 10min. Seven of 9 animals achieved resumption of spontaneous circulation (ROSC) in the TLV group vs. 5 of 11 in the C group (p=0.2). The mean pulmonary arterial temperature was lower in total liquid ventilation animals starting 4min after induction of hypothermia (TLV 36.3+/-0.2 degrees C vs. C 38.1+/-0.2 degrees C, p<0.0001). Arterial P(O)(2) was higher in total liquid ventilation animals at 2.5min of CPR (TLV 76+/-12mmHg vs. C 44+/-2mmHg; p=0.03). Induction of moderate hypothermia using perfluorocarbon-based total liquid ventilation did not improve ROSC success in this model of asphyxial cardiac arrest.