During cardiac arrest, the surface electrocardiogram (ECG) can be used to assess the state of the myocardium. The scaling exponent (ScE) is a quantitative ECG descriptor of ventricular fibrillation (VF) waveform. The ScE correlates with the duration of VF, and is predictive of rescue shock outcome in both swine and humans. Furthermore, the therapies that alter the likelihood of resuscitation also affect the ScE. This proposal will examine the mechanisms that affect rescue shock outcome and the ScE using an established, clinically relevant porcine model of prolonged VF. We will examine the effects of high-energy phosphate (HEP) depletion, ischemia, sodium, calcium, and potassium channel regulation, reperfusion, acid-base status, and temperature. These studies are innovative in that they will use a clinically available indicator (the ScE) to guide resuscitation in a whole animal model that also allows examination of resuscitation outcomes.
Our specific aims will be: 1) Define the relationships between myocardial metabolic state, changes in the VF waveform, and rescue shock outcome; 2) Define the relationships between alterations in ionic conductances, changes in the VF, and rescue shock outcome; 3) Identify a drug combination that optimally restores organization of VF, improves rescue shock outcomes, and stabilizes post-resuscitation hemodynamics. We will examine the effects of high-energy phosphate (HEP) depletion, ischemia, sodium, calcium, and potassium channel regulation, reperfusion, acid-base status, and temperature. These studies are novel because they will use a recently discovered, clinically available indicator (the ScE) in a model that will also allow examination of resuscitation outcomes.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL080483-03
Application #
7237245
Study Section
Special Emphasis Panel (ZRG1-CICS (01))
Program Officer
Lathrop, David A
Project Start
2005-09-30
Project End
2009-05-31
Budget Start
2007-06-01
Budget End
2008-05-31
Support Year
3
Fiscal Year
2007
Total Cost
$176,006
Indirect Cost
Name
University of Pittsburgh
Department
Emergency Medicine
Type
Schools of Medicine
DUNS #
004514360
City
Pittsburgh
State
PA
Country
United States
Zip Code
15213
Reynolds, Joshua C; Salcido, David; Koller, Allison C et al. (2013) Tissue oximetry by near-infrared spectroscopy in a porcine model of out-of-hospital cardiac arrest and resuscitation. Resuscitation 84:843-7
Reynolds, Joshua C; Rittenberger, Jon C; Menegazzi, James J (2012) Female sex is not associated with improved rates of ROSC or short term survival following prolonged porcine ventricular fibrillation. Resuscitation 83:1386-90
Reynolds, Joshua C; Salcido, David D; Menegazzi, James J (2012) Conceptual models of coronary perfusion pressure and their relationship to defibrillation success in a porcine model of prolonged out-of-hospital cardiac arrest. Resuscitation 83:900-6
Salcido, David D; Kim, Young-Min; Sherman, Lawrence D et al. (2012) Quantitative waveform measures of the electrocardiogram as continuous physiologic feedback during resuscitation with cardiopulmonary bypass. Resuscitation 83:505-10
Menegazzi, James J; Salcido, David D; Housler, Greggory J et al. (2012) Feasibility of initiating extracorporeal life support during mechanical chest compression CPR: a porcine pilot study. Resuscitation 83:130-3
Reynolds, Joshua C; Salcido, David D; Menegazzi, James J (2012) Correlation between coronary perfusion pressure and quantitative ECG waveform measures during resuscitation of prolonged ventricular fibrillation. Resuscitation 83:1497-502
Reynolds, Joshua C; Salcido, David D; Menegazzi, James J (2010) Coronary perfusion pressure and return of spontaneous circulation after prolonged cardiac arrest. Prehosp Emerg Care 14:78-84
Menegazzi, James J; Rittenberger, Jon C; Suffoletto, Brian P et al. (2009) Effects of pre-arrest and intra-arrest hypothermia on ventricular fibrillation and resuscitation. Resuscitation 80:126-32
Suffoletto, Brian P; Salcido, David D; Logue, Eric S et al. (2009) Ethyl pyruvate enhances intra-resuscitation hemodynamics in prolonged ventricular fibrillation arrest. Resuscitation 80:1411-6
Salcido, David D; Menegazzi, James J; Suffoletto, Brian P et al. (2009) Association of intramyocardial high energy phosphate concentrations with quantitative measures of the ventricular fibrillation electrocardiogram waveform. Resuscitation 80:946-50

Showing the most recent 10 out of 19 publications