Sodium nitroprusside enhanced cardiopulmonary resuscitation (SNPeCPR) improves vital organ perfusion pressures and carotid blood flow in a porcine model of cardiac arrest

Purpose of the studyTo describe a new method of CPR that optimizes vital organ perfusion pressures and carotid blood flow. We tested the hypothesis that a combination of high dose sodium nitroprusside (SNP) as well as non-invasive devices and techniques known independently to enhance circulation would significantly improve carotid blood flow (CBF) and return of spontaneous circulation (ROSC) rates in a porcine model of cardiac arrest.Methods15 isofluorane anesthetized pigs (30 ± 1 kg), after 6 min of untreated ventricular fibrillation, were subsequently randomized to receive either 15 min of standard CPR (S-CPR) (8 animals) or 5 min epochs of S-CPR followed by active compression–decompression (ACD) + inspiratory impedance threshold device (ITD) CPR followed by ACD + ITD + abdominal binding (AB) with 1 mg of SNP administered at minutes 2, 7, 12 of CPR (7 animals). Primary endpoints were CBF and ROSC rates. ANOVA and Fisher's exact test were used for comparisons.Results/conclusionThere was significant improvement in the hemodynamic parameters in the SNP animals. ROSC was achieved in 7/7 animals that received SNP and in 2/8 in the S-CPR (p = 0.007). CBF and end tidal CO2 (ETCO2) were significantly higher in the ACD + ITD + AB + SNP (SNPeCPR) animals during CPR. Bolus doses of SNP, when used in conjunction with ACD + ITD + AB CPR, significantly improve CBF and ROSC rates compared to S-CPR.