BODY POSITION DURING TRANSPORT AND IMMEDIATE INTRANASAL EVAPORATIVE COOLING EFFECTIVENESS ASSESSMENT IN REFRACTORY CARDIAC ARREST PORCINE MODEL

Background: Cardiac arrest patients are not transported only supine. Effect of body position on resuscitability and cerebral perfusion in 30° and 60° incline is not known.
Methods: 25 female pigs were subjected to a simulated cardiac arrest (3 min no-flow, 5 min mechanical CPR). Next, animals were randomly assigned to one of the three groups: GROUP 60 (n=8), i.e. 60° incline for 3 minutes to simulate transport in space restricted elevator; GROUP 30 (n=8), 30° incline for 8 minutes to simulate staircase transport; and GROUP 0 with no incline. During subsequent standard CPR including rescue ECMO, resuscitability and cerebral perfusion were assessed.
Results: Attainment of ROSC (3, 5, 5 in respective groups, p=0.021), time to ROSC [15:24 (13:26;16:02) vs 19:19 (18:28;19:37) vs 9:10 min (8:28;9:41), resp., p=0.005] significantly differed. Changes in carotid blood flow according to respective periods of the protocol (baseline, cardiac arrest, initial supine CPR and 30°vs. 60° CPR) are depicted in figure.
Conclusion: Positional changes during simulated refractory cardiac arrest in this experimental model significantly affect resuscitability and brain perfusion. Animals subjected to shorter time in a more inclined (GROUP 60) position were more easily resuscitated, however, cerebral blood flow was better preserved in GROUP 30.
Key words: cardiac arrest, mechanical CPR, intraarrest, intranasal evaporative cooling, brain oxygenation, brain perfusion