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Feasibility and beneficial effects of an early goal directed therapy after cardiac arrest: evaluation by conductance method

Although beneficial effects of an early goal directed therapy (EGDT) after cardiac arrest and successful return of spontaneous circulation (ROSC) have been described, clinical implementation in this period seems rather difficult. The aim of the present study was to investigate the feasibility and th...

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Autores principales: Broch, Ole, Hummitzsch, Lars, Renner, Jochen, Meybohm, Patrick, Albrecht, Martin, Rosenthal, Peter, Rosenthal, Ann-Christine, Steinfath, Markus, Bein, Berthold, Gruenewald, Matthias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935910/
https://www.ncbi.nlm.nih.gov/pubmed/33674623
http://dx.doi.org/10.1038/s41598-021-83925-3
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author Broch, Ole
Hummitzsch, Lars
Renner, Jochen
Meybohm, Patrick
Albrecht, Martin
Rosenthal, Peter
Rosenthal, Ann-Christine
Steinfath, Markus
Bein, Berthold
Gruenewald, Matthias
author_facet Broch, Ole
Hummitzsch, Lars
Renner, Jochen
Meybohm, Patrick
Albrecht, Martin
Rosenthal, Peter
Rosenthal, Ann-Christine
Steinfath, Markus
Bein, Berthold
Gruenewald, Matthias
author_sort Broch, Ole
collection PubMed
description Although beneficial effects of an early goal directed therapy (EGDT) after cardiac arrest and successful return of spontaneous circulation (ROSC) have been described, clinical implementation in this period seems rather difficult. The aim of the present study was to investigate the feasibility and the impact of EGDT on myocardial damage and function after cardiac resuscitation. A translational pig model which has been carefully adapted to the clinical setting was employed. After 8 min of cardiac arrest and successful ROSC, pigs were randomized to receive either EGDT (EGDT group) or therapy by random computer-controlled hemodynamic thresholds (noEGDT group). Therapeutic algorithms included blood gas analysis, conductance catheter method, thermodilution cardiac output and transesophageal echocardiography. Twenty-one animals achieved successful ROSC of which 13 pigs survived the whole experimental period and could be included into final analysis. cTnT and LDH concentrations were lower in the EGDT group without reaching statistical significance. Comparison of lactate concentrations between 1 and 8 h after ROSC exhibited a decrease to nearly baseline levels within the EGDT group (1 h vs 8 h: 7.9 vs. 1.7 mmol/l, P < 0.01), while in the noEGDT group lactate concentrations did not significantly decrease. The EGDT group revealed a higher initial need for fluids (P < 0.05) and less epinephrine administration (P < 0.05) post ROSC. Conductance method determined significant higher values for preload recruitable stroke work, ejection fraction and maximum rate of pressure change in the ventricle for the EGDT group. EGDT after cardiac arrest is associated with a significant decrease of lactate levels to nearly baseline and is able to improve systolic myocardial function. Although the results of our study suggest that implementation of an EGDT algorithm for post cardiac arrest care seems feasible, the impact and implementation of EGDT algorithms after cardiac arrest need to be further investigated.
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spelling pubmed-79359102021-03-08 Feasibility and beneficial effects of an early goal directed therapy after cardiac arrest: evaluation by conductance method Broch, Ole Hummitzsch, Lars Renner, Jochen Meybohm, Patrick Albrecht, Martin Rosenthal, Peter Rosenthal, Ann-Christine Steinfath, Markus Bein, Berthold Gruenewald, Matthias Sci Rep Article Although beneficial effects of an early goal directed therapy (EGDT) after cardiac arrest and successful return of spontaneous circulation (ROSC) have been described, clinical implementation in this period seems rather difficult. The aim of the present study was to investigate the feasibility and the impact of EGDT on myocardial damage and function after cardiac resuscitation. A translational pig model which has been carefully adapted to the clinical setting was employed. After 8 min of cardiac arrest and successful ROSC, pigs were randomized to receive either EGDT (EGDT group) or therapy by random computer-controlled hemodynamic thresholds (noEGDT group). Therapeutic algorithms included blood gas analysis, conductance catheter method, thermodilution cardiac output and transesophageal echocardiography. Twenty-one animals achieved successful ROSC of which 13 pigs survived the whole experimental period and could be included into final analysis. cTnT and LDH concentrations were lower in the EGDT group without reaching statistical significance. Comparison of lactate concentrations between 1 and 8 h after ROSC exhibited a decrease to nearly baseline levels within the EGDT group (1 h vs 8 h: 7.9 vs. 1.7 mmol/l, P < 0.01), while in the noEGDT group lactate concentrations did not significantly decrease. The EGDT group revealed a higher initial need for fluids (P < 0.05) and less epinephrine administration (P < 0.05) post ROSC. Conductance method determined significant higher values for preload recruitable stroke work, ejection fraction and maximum rate of pressure change in the ventricle for the EGDT group. EGDT after cardiac arrest is associated with a significant decrease of lactate levels to nearly baseline and is able to improve systolic myocardial function. Although the results of our study suggest that implementation of an EGDT algorithm for post cardiac arrest care seems feasible, the impact and implementation of EGDT algorithms after cardiac arrest need to be further investigated. Nature Publishing Group UK 2021-03-05 /pmc/articles/PMC7935910/ /pubmed/33674623 http://dx.doi.org/10.1038/s41598-021-83925-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Broch, Ole
Hummitzsch, Lars
Renner, Jochen
Meybohm, Patrick
Albrecht, Martin
Rosenthal, Peter
Rosenthal, Ann-Christine
Steinfath, Markus
Bein, Berthold
Gruenewald, Matthias
Feasibility and beneficial effects of an early goal directed therapy after cardiac arrest: evaluation by conductance method
title Feasibility and beneficial effects of an early goal directed therapy after cardiac arrest: evaluation by conductance method
title_full Feasibility and beneficial effects of an early goal directed therapy after cardiac arrest: evaluation by conductance method
title_fullStr Feasibility and beneficial effects of an early goal directed therapy after cardiac arrest: evaluation by conductance method
title_full_unstemmed Feasibility and beneficial effects of an early goal directed therapy after cardiac arrest: evaluation by conductance method
title_short Feasibility and beneficial effects of an early goal directed therapy after cardiac arrest: evaluation by conductance method
title_sort feasibility and beneficial effects of an early goal directed therapy after cardiac arrest: evaluation by conductance method
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935910/
https://www.ncbi.nlm.nih.gov/pubmed/33674623
http://dx.doi.org/10.1038/s41598-021-83925-3
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