Effect of cardiopulmonary resuscitation on perfusion in a porcine model of severe hemorrhagic shock

Authors

Patrick Greiffenstein, LSU Health Sciences Center - New OrleansFollow
Alexander Cavalea, The University of Tennessee Graduate School of Medicine
Alison Smith, LSU Health Sciences Center - New OrleansFollow
Thomas Sharp, Morsani College of Medicine
Olivia Warren, LSU Health Sciences Center - New Orleans
Jenna Dennis, LSU Health Sciences Center - New OrleansFollow
Mary C. Gatterer, Tulane University School of Medicine
Denise Danos, LSU Health Sciences Center - New OrleansFollow
Terrence C. Byrne, Tulane University School of Medicine
Amy Scarborough, LSU Health Sciences Center - New OrleansFollow
Paige Deville, LSU Health Sciences Center - New OrleansFollow
Keith Vanmeter, LSU Health Sciences Center - New OrleansFollow

Document Type

Article

Publication Date

10-8-2024

Publication Title

Journal of Trauma and Acute Care Surgery

Abstract

BACKGROUND Pulseless electrical activity from hemorrhagic shock has not been shown to benefit from cardiopulmonary resuscitation (CPR). Using a porcine model, our objective was to determine the effects of CPR on brain and skin oxygenation as a measure of perfusion in the setting of severe hemorrhagic shock. METHODS Adult swine randomized to non-CPR and CPR were anesthetized. Tissue oxygen sensors were inserted into the parietal cerebral parenchyma and skin. Controlled hemorrhagic shock with mean arterial pressure (MAP) 60 mm Hg. Measurements were obtained before, during, and after shock state. Outcomes were modeled using mixed-effects lognormal models. RESULTS A total of 12 swine were used, and the results were analyzed (non-CPR, n = 5; CPR, n = 7). One animal in the CPR group died during shock. One cerebral probe sensor malfunctioned, and these data were excluded. Baseline characteristics were similar between groups. MAP during shock was similar between groups; however, the CPR group had significantly higher systolic blood pressure (62.8 vs. 48.8 mm Hg, p = 0.010) and lower diastolic blood pressure (12.8 vs. 27.8 mm Hg, p < 0.001). Both cerebral (pBO2) and skin oxygenation (TcO2) dropped significantly as a result of shock. The CPR group had lower overall measures of tissue perfusion during shock, but only TcO2 at the shoulder was significantly lower during shock (11.5 vs. 21.1 mm Hg, p = 0.027) and recovery (33.3 vs. 62 mm Hg, p = 0.033). CONCLUSION Our model showed that adding CPR during hemorrhagic shock did not improve end-organ oxygenation/perfusion, but did significantly diminish skin perfusion. This experiment corroborates existing literature on the potential detrimental effects of CPR during hemorrhagic pulseless electrical activity, but further work is needed to confirm this observation.

PubMed ID

39375890

Chapter Title

0000000000004437 - Effect of cardiopulmonary resuscitation on perfusion in a porcine model of severe hemorrhagic shock

Recommended Citation

Greiffenstein, Patrick; Cavalea, Alexander; Smith, Alison; Sharp, Thomas; Warren, Olivia; Dennis, Jenna; Gatterer, Mary C.; Danos, Denise; Byrne, Terrence C.; Scarborough, Amy; Deville, Paige; and Vanmeter, Keith, "Effect of cardiopulmonary resuscitation on perfusion in a porcine model of severe hemorrhagic shock" (2024). School of Medicine Faculty Publications. 3016.
https://digitalscholar.lsuhsc.edu/som_facpubs/3016
10.1097/TA.0000000000004437