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Sep 21, 2017

Resuscitation 2017

Spontaneous hypertrophic cardiomyopathy in pigs: a possible cause of misleading results in porcine models of cardiac arrest and cardiopulmonary resuscitation.

;

Ángel Caballero;

Marta Magaldi;

Antonio López-Hernández;

José Maria Gómez;

Mireia Chanzá;

Jaume Fontanals

cardiopulmonary resuscitation

animal models

hypertrophic cardiomyopathy

Abstract

Abstract

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Keywords

cardiopulmonary resuscitation

animal models

hypertrophic cardiomyopathy

Abstract

Background and purpose: Experimental models of cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) are essential to broaden knowledge of the underlying pathophysiology of CA and thus improve CPR techniques. Porcine models provide clinically relevant data and represent the 40% of the experimental models of CA-CPR. In pig population, hypertrophic cardiomyopathy (HCM), an autosomal dominant disease, has an estimated frequency range from 5 to 23% depending on the breed (1). This report aims to depict the attempt to resuscitate a pig with spontaneous HCM in an experimental study of CA-CPR. Methods: A cardiac arrest was induced in 14 Landrance x Largewhite female pigs (27±2 kg). After 5 minutes of untreated ventricular fibrillation (VF) animals were resuscitated. CPR with automated chest compressions (LUCAS device) was performed until return of spontaneous circulation (ROSC). External defibrillations (DFS) and intravenous adrenaline were protocolled according the current CPR guidelines (2). Results: Thirteen out of 14 animals were successfully resuscitated. CPR maneuvres resulted in proper mean arterial pressure (61,1±16,1 mmHg) until ROSC (7,4±4,4 minutes). A total of 3,3±2,4 DFS and 1,1±1,1 mg of adrenaline were given. However, one animal was unable to resuscitate after 20 minutes of CPR, presenting pulseless electrical activity after 17 minutes of induction of VF. Moreover, chest compressions failed to maintain adequate mean arterial pressure (17,2±5,8 mmHg) during CPR. A total of 4 DFS were applied and 5 bolus of 1 mg of adrenaline were administered. The necropsy of the animal revealed a pathologic hypertrophic heart (Image). Conclusions: In a porcine model of 5-minutes CA, standard CPR resulted in ROSC after 7,4±4,4 minutes in healthy pigs, but was ineffective in a pig with HCM. The unaware inclusion of pigs with spontaneous HCM in porcine models of CA-CPR could lead to misleading conclusions when a complete heart inspection in necropsy is not performed. (1) Lin J-H, Huang S-Y, Lee W-C, Liu S-K, Chu R-M. Echocardiographic features of pigs with spontaneous hypertrophic cardiomyopathy. Comp Med 2002;52:238–42. (2) Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. European Resuscitation Council Guidelines for Resuscitation 2015. Section 3. Adult advanced life support. Resuscitation 2015;95:100–47.

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© Copyright 2019 Morressier GmbH.
All rights reserved.