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Cardioplegia defibrillation of circulatory and metabolic phase ventricular fibrillation in a swine model.

Resuscitation 2019 September 19
INTRODUCTION: We previously found potassium cardioplegia followed by rapid calcium reversal (Kplegia) can achieve defibrillation in a swine model of electrical phase of ventricular fibrillation (VF) comparable to standard care.

HYPOTHESIS: Exploring 3 possible potassium dose and timing protocols, we hypothesize Kplegia may benefit resuscitation of longer duration untreated VF.

METHODS: Three separate blinded randomized placebo-controlled trials were performed with electrically-induced VF untreated for durations of 6,9, and 12 minutes in a swine model. Experimental groups received infusion of 1 or 2 boluses of intravenous (IV) potassium followed by a single calcium reversal bolus. Potassium was replaced by saline in the control groups. Outcomes included: amplitude spectrum area (AMSA) during VF, resulting rhythms, number of defibrillations, return of spontaneous circulation (ROSC), and hemodynamics for 1 hour post ROSC. Binomial and interval data outcomes were compared with exact statistics. Serial interval data were assessed with mixed regression models.

RESULTS: Twelve, 12, and 8 animals were included at 6, 9, and 12 minute VF durations for a total of 32. ROSC was achieved in: 4/6 Kplegia and 3/6 control animals in the 6 minute protocol,(p = 1.00), 4/6 Kplegia and 2/6 control animals in the 9 minute protocol,(p = 0.57), and 0/5 Kplegia and 1/3 control animals in the 12 minute protocol,(p = 0.38). Two of 8 Kplegia animals achieved ROSC with chemical defibrillation alone.

CONCLUSIONS: The majority of animals achieved ROSC after up to 9 minutes of untreated VF arrest using K plegia protocols. K plegia requires further optimization for both peripheral IV and intraosseous infusion, and to assess for superiority over standard care. Institutional Animal Care and Use Committee protocol #15127224.

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