Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine

Summary

Cardiopulmonary resuscitation and defibrillation are the only effective therapeutic options during cardiac arrest caused by ventricular fibrillation. This model presents a standardized regimen to induce, assess, and treat this physiological state in a porcine model, thus providing a clinical approach with various opportunities for data collection and analysis.

Abstract

Cardiopulmonary resuscitation after cardiac arrest, independent of its origin, is a regularly encountered medical emergency in hospitals as well as preclinical settings. Prospective randomized trials in human subjects are difficult to design and ethically ambiguous, which results in a lack of evidence-based therapies. The model presented in this report represents one of the most common causes of cardiac arrests, ventricular fibrillation, in a standardized setting in a large animal model. This allows for reproducible observations and various therapeutic interventions under clinically accurate conditions, hence facilitating the generation of better evidence and eventually the potential for improved medical treatment.

Introduction

Cardiac arrest and cardiopulmonary resuscitation (CPR) are regularly encountered medical emergencies in hospital wards as well as preclinical emergency provider scenarios^1,2. While there have been extensive efforts to characterize the optimal treatment for this situation^3,4,5,6, international guidelines and expert recommendations (e.g., ERC and ILCOR) usually rely on low-grade evidence due to the lack of prospective randomized trials^3,

Protocol

The experiments in this protocol were approved by the State and Institutional Animal Care Committee (Landesuntersuchungsamt Rheinland-Pfalz, Koblenz, Germany; Chairperson: Dr. Silvia Eisch-Wolf; approval no. G16-1-042). The experiments were conducted in accordance with the ARRIVE guidelines. Seven anesthetized male pigs (sus scrofa domestica) with a mean weight of 30 ± 2 kg and 12-16 weeks in age were included in the protocol.

1. Anesthesia, intubation, and mechanical ventilation^13,14

1. Maintain animals in their normal environment as long as possible to minim....

Results

Cardiac arrest was induced in seven pigs. Return of spontaneous circulation following CPR was achieved in four Pigs (57%) with a mean of 3 ± 1 biphasic defibrillations. Healthy and adequately anesthetized pigs should stay in supine position without shivering and signs of agitation throughout the entire experiment. Mean arterial blood pressures should not drop below 50 mmHg before initiation of fibrillation¹⁸. For optimal results, blood gas analyses can be performed.......

Discussion

Some major technical issues regarding anesthesia in a porcine model have previously been described by our group^13,14. These include the strict avoidance of stress and unnecessary pain for the animals, possible anatomical problems during airway management, and specific personnel requirements¹⁹.

Additionally, the benefits of ultrasound-guided catheterization was highlighted previously and remains the preferable ap.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
1 M- Kaliumchlorid-Lösung 7,46% 20ml	Fresenius, Kabi Deutschland GmbH		potassium chloride
Arterenol 1mg/ml 25 ml	Sanofi- Aventis, Seutschland GmbH		norepinephrine
Atracurium Hikma 50mg/5ml	Hikma Pharma GmbH, Martinsried		atracurium
BD Discardit II Spritze 2,5,10,20 ml	Becton Dickinson S.A. Carretera Mequinenza Fraga, Spain		syringe
BD Luer Connecta	Becton Dickinson Infusion Therapy AB Helsingborg, Schweden		3-way-stopcock
BD Microlance 3 20 G	Becton Dickinson S.A. Carretera Mequinenza Fraga, Spain		canula
CorPatch Easy Electrodes	CorPuls, Kaufering, Germany		defibrillator electrodes
Corpuls 3	Corpuls, Kaufering, Germany		defibrillator
Datex Ohmeda S5	GE Healthcare Finland Oy, Helsinki, Finland		hemodynamic monitor
Engström Carestation	GE Heathcare, Madison USA		ventilator
Fentanyl-Janssen 0,05mg/ml	Janssen-Cilag GmbH, Neuss		fentanyl
Führungsstab, Durchmesser 4.3	Rüsch		endotracheal tube introducer
Incetomat-line 150 cm	Fresenius, Kabi Deutschland GmbH		perfusorline
Ketamin-Hameln 50mg/ml	Hameln Pharmaceuticals GmbH		ketamine
laryngoscope	Rüsch		laryngoscope
logicath 7 Fr 3-lumen 30cm lang	Smith- Medical Deutschland GmbH		central venous catheter
LUCAS-2	Physio-Control/Stryker, Redmond, WA, USA		chest compression device
Masimo Radical 7	Masimo Corporation Irvine, Ca 92618 USA		periphereal oxygen saturation
Neofox Oxygen sensor 300 micron fiber	Ocean optics Largo, FL USA		ultrafast pO2-measurements
Ölsäure reinst Ph. Eur NF C18H34O2 M0282,47g/mol Dichte 0,9	Applichem GmbH Darmstadt, Deutschland		oleic acid
Original Perfusor syringe 50ml Luer Lock	B.Braun Melsungen AG, Germany		perfusorsyringe
Osypka pace, 110 cm	Osypka Medical GmbH, Rheinfelden-Herten, Germany		Pacing/fibrillation catheter
PA-Katheter Swan Ganz 7,5 Fr 110cm	Edwards Lifesciences LLC, Irvine CA, USA		PAC
Percutaneous sheath introducer set 8,5 und 9 Fr, 10 cm with integral haemostasis valve/sideport	Arrow international inc. Reading, PA, USA		introducer sheath
Perfusor FM Braun	B.Braun Melsungen AG, Germany		syringe pump
Propofol 2% 20mg/ml (50ml flasks)	Fresenius, Kabi Deutschland GmbH		propofol
Radifocus Introducer II, 5-8 Fr	Terumo Corporation Tokio, Japan		introducer sheath
Rüschelit Super Safety Clear >ID 6/ 6,5 /7,0 mm	Teleflex Medical Sdn. Bhd, Malaysia		endotracheal tube
Seldinger Nadel mit Fixierflügel	Smith- Medical Deutschland GmbH		seldinger canula
Sonosite Micromaxx Ultrasoundsystem	Sonosite Bothell, WA, USA		ultrasound
Stainless Macintosh Größe 4	Welsch Allyn69604		blade for laryngoscope
Stresnil 40mg/ml	Lilly Deutschland GmbH, Abteilung Elanco Animal Health		azaperone
Vasofix Safety 22G-16G	B.Braun Melsungen AG, Germany		venous catheter
Voltcraft Model 8202	Voltcraft, Hirschau, Germany		oscilloscope/function generator