Name: standardized model of ventricular fibrillation and advanced cardiac life support in swine
Uploaded: 2020-01-30T15:30:00
Description: Watch this Scientific Journal Video about Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine at JoVE.com

The authors want to thank Dagmar Dirvonskis for excellent technical support.

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 &#177; 2 kg and 12-16 weeks in age were included in the protocol.
1. Anesthesia, intubation, and mechanical ventilation<s...

<ol>
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K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correlation+of+thermodilution-derived+extravascular+lung+water+and+ventilation/perfusion-compartments+in+a+porcine+model.">Correlation of thermodilution-derived extravascular lung water and ventilation/perfusion-compartments in a porcine model.</a> Intensive Care Medicine. 39 (7), 1313-1317 (2013).</li><li>Hartmann, E. 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Some major technical issues regarding anesthesia in a porcine model have previously been described by our group13,14. 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...

Cardiac arrest and cardiopulmonary resuscitation (CPR) are regularly encountered medical emergencies in hospital wards as well as preclinical emergency provider scenarios1,2. While there have been extensive efforts to characterize the optimal treatment for this situation3,4,5,6, international guidelines and expert recommendations (e.g., ERC and ILCOR) usually rely on low-grade evidence due to the lack of prospective randomized trials3,4,5,7,8,9. This is in part due to obvious ethical reservations regarding randomized resuscitation protocols in human trials10. However, this may also point towards a lack of strict protocol adherence when confronted with a life-threatening and stressful situation11,12. The protocol presented in this report aims to provide a standardized resuscitation model in a realistic clinical setting, which generates valuable, prospective data while being as valid and accurate as possible without the need for human subjects. It adheres to common resuscitation guidelines, can be easily applied, and enables researches to examine and characterize various aspects and interventions in a critical but controlled setting. This will lead to 1) a better understanding of the pathological mechanisms underlying cardiac arrest and ventricular fibrillation and 2) higher quality evidence in order to optimize treatment options and increase survival rates.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>1 M- Kaliumchlorid-L&#246;sung 7,46% 20ml</td>
			<td>Fresenius, Kabi Deutschland GmbH</td>
			<td></td>
			<td>potassium chloride</td>
		</tr>
		<tr>
			<td>Arterenol 1mg/ml 25 ml</td>
			<td>Sanofi- Aventis, Seutschland GmbH</td>
			<td></td>
			<td>norepinephrine</td>
		</tr>
		<tr>
			<td>Atracurium Hikma 50mg/5ml</td>
			<td>Hikma Pharma GmbH, Martinsried</td>
			<td></td>
			<td>atracurium</td>
		</tr>
		<tr>
			<td>BD Discardit II Spritze 2,5,10,20 ml</td>
			<td>Becton Dickinson S.A. Carretera Mequinenza Fraga, Spain</td>
			<td></td>
			<td>syringe</td>
		</tr>
		<tr>
			<td>BD Luer Connecta</td>
			<td>Becton Dickinson Infusion Therapy AB Helsingborg, Schweden</td>
			<td></td>
			<td>3-way-stopcock</td>
		</tr>
		<tr>
			<td>BD Microlance 3 20 G</td>
			<td>Becton Dickinson S.A. Carretera Mequinenza Fraga, Spain</td>
			<td></td>
			<td>canula</td>
		</tr>
		<tr>
			<td>CorPatch Easy Electrodes</td>
			<td>CorPuls, Kaufering, Germany</td>
			<td></td>
			<td>defibrillator electrodes</td>
		</tr>
		<tr>
			<td>Corpuls 3</td>
			<td>Corpuls, Kaufering, Germany</td>
			<td></td>
			<td>defibrillator</td>
		</tr>
		<tr>
			<td>Datex Ohmeda S5</td>
			<td>GE Healthcare Finland Oy, Helsinki, Finland</td>
			<td></td>
			<td>hemodynamic monitor</td>
		</tr>
		<tr>
			<td>Engstr&#246;m Carestation</td>
			<td>GE Heathcare, Madison USA</td>
			<td></td>
			<td>ventilator</td>
		</tr>
		<tr>
			<td>Fentanyl-Janssen 0,05mg/ml</td>
			<td>Janssen-Cilag GmbH, Neuss</td>
			<td></td>
			<td>fentanyl</td>
		</tr>
		<tr>
			<td>F&#252;hrungsstab, Durchmesser 4.3</td>
			<td>R&#252;sch</td>
			<td></td>
			<td>endotracheal tube introducer</td>
		</tr>
		<tr>
			<td>Incetomat-line 150 cm</td>
			<td>Fresenius, Kabi Deutschland GmbH</td>
			<td></td>
			<td>perfusorline</td>
		</tr>
		<tr>
			<td>Ketamin-Hameln 50mg/ml</td>
			<td>Hameln Pharmaceuticals GmbH</td>
			<td></td>
			<td>ketamine</td>
		</tr>
		<tr>
			<td>laryngoscope</td>
			<td>R&#252;sch</td>
			<td></td>
			<td>laryngoscope</td>
		</tr>
		<tr>
			<td>logicath 7 Fr 3-lumen 30cm lang</td>
			<td>Smith- Medical Deutschland GmbH</td>
			<td></td>
			<td>central venous catheter</td>
		</tr>
		<tr>
			<td>LUCAS-2</td>
			<td>Physio-Control/Stryker, Redmond, WA, USA</td>
			<td></td>
			<td>chest compression device</td>
		</tr>
		<tr>
			<td>Masimo Radical 7</td>
			<td>Masimo Corporation Irvine, Ca 92618 USA</td>
			<td></td>
			<td>periphereal oxygen saturation</td>
		</tr>
		<tr>
			<td>Neofox Oxygen sensor 300 micron fiber</td>
			<td>Ocean optics Largo, FL USA</td>
			<td></td>
			<td>ultrafast pO2-measurements</td>
		</tr>
		<tr>
			<td>&#214;ls&#228;ure reinst Ph. Eur NF C18H34O2 M0282,47g/mol Dichte 0,9</td>
			<td>Applichem GmbH Darmstadt, Deutschland</td>
			<td></td>
			<td>oleic acid</td>
		</tr>
		<tr>
			<td>Original Perfusor syringe 50ml Luer Lock</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td>perfusorsyringe</td>
		</tr>
		<tr>
			<td>Osypka pace, 110 cm</td>
			<td>Osypka Medical GmbH, Rheinfelden-Herten, Germany</td>
			<td></td>
			<td>Pacing/fibrillation catheter</td>
		</tr>
		<tr>
			<td>PA-Katheter Swan Ganz 7,5 Fr 110cm</td>
			<td>Edwards Lifesciences LLC, Irvine CA, USA</td>
			<td></td>
			<td>PAC</td>
		</tr>
		<tr>
			<td>Percutaneous sheath introducer set 8,5 und 9 Fr, 10 cm with integral haemostasis valve/sideport</td>
			<td>Arrow international inc. Reading, PA, USA</td>
			<td></td>
			<td>introducer sheath</td>
		</tr>
		<tr>
			<td>Perfusor FM Braun</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td>syringe pump</td>
		</tr>
		<tr>
			<td>Propofol 2% 20mg/ml (50ml flasks)</td>
			<td>Fresenius, Kabi Deutschland GmbH</td>
			<td></td>
			<td>propofol</td>
		</tr>
		<tr>
			<td>Radifocus Introducer II, 5-8 Fr</td>
			<td>Terumo Corporation Tokio, Japan</td>
			<td></td>
			<td>introducer sheath</td>
		</tr>
		<tr>
			<td>R&#252;schelit Super Safety Clear &#62;ID 6/ 6,5 /7,0 mm</td>
			<td>Teleflex Medical Sdn. Bhd, Malaysia</td>
			<td></td>
			<td>endotracheal tube</td>
		</tr>
		<tr>
			<td>Seldinger Nadel mit Fixierfl&#252;gel</td>
			<td>Smith- Medical Deutschland GmbH</td>
			<td></td>
			<td>seldinger canula</td>
		</tr>
		<tr>
			<td>Sonosite Micromaxx Ultrasoundsystem</td>
			<td>Sonosite Bothell, WA, USA</td>
			<td></td>
			<td>ultrasound</td>
		</tr>
		<tr>
			<td>Stainless Macintosh Gr&#246;&#223;e 4</td>
			<td>Welsch Allyn69604</td>
			<td></td>
			<td>blade for laryngoscope</td>
		</tr>
		<tr>
			<td>Stresnil 40mg/ml</td>
			<td>Lilly Deutschland GmbH, Abteilung Elanco Animal Health</td>
			<td></td>
			<td>azaperone</td>
		</tr>
		<tr>
			<td>Vasofix Safety 22G-16G</td>
			<td>B.Braun Melsungen AG, Germany</td>
			<td></td>
			<td>venous catheter</td>
		</tr>
		<tr>
			<td>Voltcraft Model 8202</td>
			<td>Voltcraft, Hirschau, Germany</td>
			<td></td>
			<td>oscilloscope/function generator</td>
		</tr>
	</tbody>
</table>

standardized model of ventricular fibrillation and advanced cardiac life support in swine

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.

Cardiac arrest was induced in seven pigs. Return of spontaneous circulation following CPR was achieved in four Pigs (57%) with a mean of 3 &#177; 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 perf...

Watch this Scientific Journal Video about Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine at JoVE.com

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

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.

Cardiopulmonary resuscitation after cardiac arrest, independent of its origin, is a regularly encountered medical emergency in hospitals as well as ...

Standardizing a resuscitation model in animals with a comparable cardiopulmonary physiology to humans helps in the study and understanding of novel therapy options to ultimately improve patient outcomes. For proper application of the model and adequate interpretations of the results, expertise in emergency medicine and the intensive care of critically ill patients is highly recommended. The main advantage of this procedure is the improved sensational applicability of positive results and in an otherwise extra challenging experimental setting.Initial demonstrating the experimental setup can help significantly since the electrode and compression pad placement are crucial for successful execution and are often described solely through text alone. This protocol provides deeper insights into resuscitation mechanism for critical and intensive care providers in pre-hospital and clinical settings. After placement of the trans-pulmonal thermodilution catheter into the sedated, experimental pig, place one defibrillator patch electrode anterior on the torso and one posterior electrode on the central left hemithorax.Connect the electrodes to a defibrillator to establish ECG and immobilize the pig inside a vacuum mattress. Deflate the mattress to prevent unwanted movement during CPR and secure the limbs. Place a chest compression device around the chest and under the vacuum mattress according to the manufacturer's recommendations and adjust the pressure pad to the lower third of the sternum in median position.For optimal positioning of the chest compression device, the animal may have to be shifted sideway within the deflated mattress. When the device is in place, power on the device and lower the pressure pad to the skin. Press pause to prepare the device for chest compressions and insert a fibrillation-pacing catheter inside the left femoral vein through the IV sheath.Inflate the catheter cuff with one to two milliliters of air and slowly push the inflated cuff about 50 centimeters until it is positioned next to the right atrium. Connect the catheter electrodes to an adequate oscilloscope function generator and adjust the fibrillation parameters to the appropriate experimental values. Next turn on the generator while monitoring the ECG changes, moving the catheter slowly forward until arrhythmias can be detected in the ECG.Carefully vary the catheter position until ventricular fibrillation can be detected. Once ventricular fibrillation has been confirmed, turn off the generator and deflate and remove the fibrillation catheter. Then press play on the compression device to start mechanical chest compressions.To interrupt the chest compressions, press the pause button on the compression device. Analyze the ECG patterns. If ventricular fibrillation persists, enter the manual mode in the defibrillator menu and adjust the energy to 200 joules by phasic.Press the load button and wait until acoustic signal turns on to indicate a prepared shock value before initiating the electric shock. In the case of the return of spontaneous circulation, stop the chest compressions, continue ventilation, and apply monitoring as extensively and for as long as needed. Pacing catheter induced cardiac arrest can be assumed if the ECG readings show ventricular fibrillation and no cardiac output or pressure variations are measured by the arterial line.Once the chest compressions have been started, sufficient cardiac output generation is indicated by a mean arterial pressure of 30 to 50 milliliters of mercury and, if adhering to resuscitation guidelines, the administration of one milligram of adrenaline result in a substantial rise in blood pressure within one minute. The return of spontaneous circulation is confirmed by a dramatic increase in the expiratory carbon dioxide measurements and an organized heart rhythm in the ECG in the respective cardiac output as observed by arterial measurement. Hypercapnia and a decreased Horovitz index are commonly observed after the return of spontaneous circulation and a reestablishment of controlled mechanical ventilation leads to recompensation and stable respiratory conditions.Misplacing or dislodging the chest compression device during the experiment jeopardizes the results. Therefore care should be taken to avoid repositioning. With this procedure, a standardized evaluation of the cardiac output and the ventilation-perfusion ratio during resuscitation can be performed to characterize extensively cardiopulmonary effects.Standardized resuscitation models have to identify novel ventilation techniques during CPR, potentially helping to improve patient outcome. When attempting protocols that use defibrillation and oscilloscopes, adequate expertise and caution are paramount to preventing life threatening situations and injury.

Research

JoVE Journal

Medicine

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