Excellent coronary perfusion pressure during cardiopulmonary resuscitationis not good enough to ensure long-term survival with good neurologic outcome: a porcine case report

Purpose: To report a case of cerebral ischemia confirmed by magnetic resona nce imaging after successful cardiopulmonary resuscitation (CPR) complicate d by acute respiratory injury. Materials and methods: After 4 min of cardia c arrest, followed by 3 min of basic life support CPR, a female pig weighin g 38 kg received every 5 min vasopressin (0.4, 0.4 and 0.8 U/kg). After 22 min of cardiac arrest, including 18 min of CPR, one defibrillation attempt employing 100 J resulted in return of spontaneous circulation. Neurological evaluation was performed 24 and 96 h after successful CPR. Magnetic resona nce imaging was carried out 4 days after CPR using a clinical 1.5 T scanner . The magnetic resonance imaging protocol consisted of fast spinecho T2-wei ghted, as well as spinecho T1-weighted imaging of the brain. Results: CPR w ith vasopressin resulted in excellent coronary perfusion pressure ranging b etween 35 and 60 mmHg throughout CPR. Eight minutes after initiation of che st compressions, bleeding out of the tracheal tube occurred. This was later confirmed as originating from bilateral bloody pulmonary infiltrations, re sulting in acute respiratory injury in the post-resuscitation phase. Ninety -six hours after successful CPR, magnetic resonance imaging revealed bilate ral diffuse cerebral vasogenic edema. Conclusion: Although excellent corona ry perfusion pressure renders a return of spontaneous circulation more like ly, complications such as acute respiratory injury in the post-resuscitatio n phase have to be managed carefully in order to ensure good neurological r ecovery from cardiac arrest. (C) 2000 Elsevier Science Ireland Ltd. All rig hts reserved.