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Hypertonic saline/hydroxy-ethyl starch infusion during CPR from out-of-hospital cardiac arrest: a randomized preclinical trial: A-2

Krep, H.; Schaefers, B.; Bender, R.; Breil, M.; Heister, U.; Hoeft, A.; Fischer, M.

European Journal of Anaesthesiology: May 2005 - Volume 22 - Issue - p 1
ESA Best Abstract Prize Competition (BAPC)
Free
SDC

Department of Anesthesiology and Intensive Care, University Clinics of Bonn, Bonn, Germany

Background and Goal of Study: Infusion of hypertonic saline (7.2%) during cardiopulmonary resuscitation (CPR) improved in animal models resuscitation success rate, and myocardial as well as cerebral blood flow (1-3). The concept of volume expansion during CPR was tested in a randomized, double-blinded, prospective preclinical trial.

Methods: 200 patients with out-of-hospital cardiac arrest (CA) of presumed cardiac origin, age 18-80 years, duration of untreated CA ≤ 16 min, and body weight ≤125 kg, either received 2 ml/kg/10min HyperHAES® (7.2% NaCI in 6% hydroxyl-ethyl-starch [HES]; Fresenius Kabi, Bad Homburg, BRD) or HES 6% i.v. during CPR performed according to the AHA-guidelines. Endpoints of the study were return of spontaneous circulation (ROSC), hospital admission, and neurologic outcome at hospital discharge. Neurologic outcome was assessed using the cerebral performance category (CPC).

Results and Discussion: ROSC was achieved in 61/101 (60.4%) patients receiving HyperHAES® and in 59/99 (59.6%) receiving HES 6%. Hospital admission rates were 54.5% (HyperHAES®) and 48.5% (HES 6%). 23 (22.8%) patients in the HyperHAES®- and 22 (22.2%) in the HES-group were discharged from the hospital, and significantly more patients with favorable neurologic outcome (CPC 1 and 2) after volume expansion during CPR with HyperHAES® (12 vs. 5 [HES]; CPC 3 and 4:11 vs. 17 [HES]; P < 0.05, Pearson's chi square test). Plasma sodium concentration increased to 175 ± 28 mmol/l during application of HyperHAES®, but already decreased to 146 ± 6 mmol/l at hospital admission.

Conclusion: Infusion of 2 ml/kg/10 min HyperHAES® during CPR is safe and might improve neurologic outcome after out-of-hospital CA. Improved neurologic outcome is presumably due to reduced postischemic cerebral reperfusion disturbances. A clinical multicenter study is required to prove that the concept of osmotic volume expansion during CPR is an effective measure to reduce neurologic damage after CA.

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References:

1 Fischer M, Dahmen A, Standop J, et al. Resuscitation 2002; 54: 269-80.
2 Breil M, Krep H, Sinn D, et al. Resuscitation 2003; 56: 307-17.
3 Krep H, Breil M, Sinn D, et al. Resuscitation 2004; 63: 73-83.
© 2005 European Society of Anaesthesiology