Author + information
- Received July 15, 2019
- Revision received November 26, 2019
- Accepted November 26, 2019
- Published online February 24, 2020.
- Adrian Ripeckyj, BAa,
- Marinos Kosmopoulos, MDa,
- Kadambari Shekar, MSa,
- Claire Carlson, DOa,
- Rajat Kalra, MDa,
- Jennifer Rees, PhDa,
- Tom P. Aufderheide, MD, MSb,
- Jason A. Bartos, MD, PhDa,c and
- Demetris Yannopoulos, MDa,c,∗ ()
- aCardiovascular Division, University of Minnesota, Minneapolis, Minnesota
- bDepartment of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- cCenter for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota
- ↵∗Address for correspondence:
Dr. Demetris Yannopoulos, Center for Resuscitation Medicine, Office of Academic Clinical Affairs, University of Minnesota Medical School, 420 Delaware Street, Southeast, MMC 508 Mayo, Minneapolis, Minnesota 55455.
• SNPeCPR improves coronary perfusion pressure, tissue perfusion, and carotid blood flow compared to epinephrine-based standard advanced cardiac life support.
• In a porcine model of prolonged resuscitation, SNPeCPR was associated with decreased arterial oxygen saturation but improved tissue oxygen delivery due to improvement in blood flow.
• Oxygen supplementation led to alleviation of hypoxemia and maintenance of the SNPeCPR hemodynamic benefits.
• Arterial oxygen saturation must be a safety endpoint that will be prospectively assessed in the first SNPeCPR clinical trial in humans.
Sodium nitroprusside–enhanced cardiopulmonary resuscitation has shown superior resuscitation rates and neurologic outcomes in large animal models supporting the need for a randomized human clinical trial. This study is the first to show nonselective pulmonary vasodilation as a potential mechanism for the hemodynamic benefits. The pulmonary shunting that is created requires increased oxygen treatment, but the overall improvement in blood flow increases minute oxygen delivery to tissues. In this context, hypoxemia is an important safety endpoint and a 100% oxygen ventilation strategy may be necessary for the first human clinical trial.
- cardiopulmonary resuscitation
- coronary perfusion pressure
- lactic acid
- pulmonary vasodilation
- sodium nitroprusside
This study was funded by an R01 research grant (R01HL108926) from the National Institutes of Health National Heart, Lung, and Blood Institute to Dr. Yannopoulos. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Basic to Translational Science author instructions page.
- Received July 15, 2019.
- Revision received November 26, 2019.
- Accepted November 26, 2019.
- 2020 The Authors