Pulmonary vasodilation during cardiopulmonary resuscitation – A randomized, controlled porcine study

During resuscitation pulmonary artery pressure (PAP) increases. This reduces left ventricular filling, leading to decreased blood flow. Inhaled nitric oxide (iNO) produces selective pulmonary vasodilation. We hypothesized that iNO would lower PAP during resuscitation resulting in increased survival....

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Published in:Resuscitation 2024-09, Vol.202, p.110329, Article 110329
Main Authors: Nørholt, Casper, Johannsen, Cecilie M., Baltsen, Cecilie D., Lund, Margrete H., Kjærsgaard, Lykke, Solberg, Sara M.A., Hørsdal, Oskar K., Vammen, Lauge, Dam Lyhne, Mads, Andersen, Lars W., Granfeldt, Asger
Format: Article
Language:English
Subjects:
Administration, Inhalation
Advanced Life Support
Animals
Cardiac arrest
Cardiopulmonary Resuscitation
Cardiopulmonary Resuscitation - methods
Cardiovascular research
Disease Models, Animal
Emergency medicine
Female
Heart Arrest - therapy
Inhaled nitric oxide
Intensive Care
Male
Myocardial ischemia
Nitric Oxide - administration & dosage
Pulmonary Artery - drug effects
Pulmonary Artery - physiopathology
Pulmonary vasodilation therapy
Random Allocation
Resuscitation outcomes
Return of Spontaneous Circulation
Swine
Vasodilation - drug effects
Vasodilation - physiology
Ventricular fibrillation
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Summary:During resuscitation pulmonary artery pressure (PAP) increases. This reduces left ventricular filling, leading to decreased blood flow. Inhaled nitric oxide (iNO) produces selective pulmonary vasodilation. We hypothesized that iNO would lower PAP during resuscitation resulting in increased survival. 30 pigs (40 kg) were subjected to cardiac arrest for 9.5 min after myocardial ischemia induced by coronary artery occlusion of the left anterior descending artery and ventricular fibrillation. During resuscitation, the pigs were randomized to 40 ppm iNO or placebo. The primary outcome was return of spontaneous circulation (ROSC). Pigs achieving ROSC underwent 4-hours intensive care. The ROSC rate was 9/14 (64%) in the control group and 11/16 (69%) in the iNO group (OR 1.2 95%CI [0.3;5.6], p > 0.99). There was no difference in diastolic aorta pressure/PAP ratio (mean difference −0.99 [95% CI: −2.33–0.36], p = 0.14). Mean pulmonary artery pressure was lower in the iNO group 60 and 120 min after ROSC (mean difference: −12.18 mmHg [95%CI: −16.94; −7.43] p 
ISSN:0300-9572
1873-1570
1873-1570
DOI:10.1016/j.resuscitation.2024.110329