SELECTIVE AORTIC-ARCH PERFUSION DURING CARDIAC-ARREST - ENHANCED RESUSCITATION USING OXYGENATED PERFLUBRON EMULSION, WITH AND WITHOUT AORTIC-ARCH EPINEPHRINE

Study objective: To evaluate selective aortic arch perfusion (SAAP) wi th an oxygenated fluorocarbon emulsion, with and without aortic arch e pinephrine during cardiac arrest. Methods: This randomized, controlled study, undertaken at a university research laboratory, involved 15 mi xed-breed dogs. After 10 minutes of ventricular fibrillation and 30 se conds of CPR, the dogs were randomized to three groups, each comprisin g five dogs. Group 1 (controls) dogs were given CPR and intravenous ep inephrine (IVE) mg/kg, al 10.5 minutes and then every 3 minutes. Group 2 dogs (IVE-SAAP) were treated with CPR and intravenous epinephrine ( IVE) in the same fashion as the control group hut were also subjected to SAAP with 275 mi of oxygenated 60% wt/vol perflubron emulsion over 30 seconds. Group 3 dogs (AoE-SAAP) received the same treatment as the IVE-SAAP group, except that the first epinephrine dose was given intr aaortically. Results: Coronary perfusion pressure (CPP) increased duri ng SAAP in both the IVE-SAAP and AoE-SAAP groups but was greater in th e AoE-SAAP group. CPR diastolic CPP after SAAP was significantly great er in the AoE-SAAP group than in the control group. Return of spontane ous circulation (ROSC) occurred in two control dogs, all five IVE-SAAP dogs, and all five AoE-SAAP dogs. The time elapsed from the initiatio n of CPR to ROSC was 6.1+/-1.9 minutes in the AoE-SAAP group, compared with 11.0+/-5.8 minutes in the IVE-SAAP group. Conclusion: SAAP with oxygenated perflubron emulsion improved ROSC, both with and without ao rtic arch epinephrine. The combination of SAAP with perflubron emulsio n and aortic arch epinephrine resulted in higher CPP and more rapid RO SC.