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. 2017 Jun 20;130(12):1475-1480.
doi: 10.4103/0366-6999.207481.

Variations of Postresuscitation Lung Function after Thrombolysis Therapy in a Cardiac Arrest Porcine Model Caused by Pulmonary Thromboembolism

Jun Yang  1 , Lian-Xing Zhao  2 , Chun-Sheng Li  1 , Nan Tong  1 , Hong-Li Xiao  1 , Le An  1
Affiliations

Variations of Postresuscitation Lung Function after Thrombolysis Therapy in a Cardiac Arrest Porcine Model Caused by Pulmonary Thromboembolism

Jun Yang et al. Chin Med J (Engl). .

Abstract

Background: Study of lung function in survivor from cardiac arrest (CA) caused by pulmonary thromboembolism (PTE) was rare. The aim of this study was to investigate the variations of postresuscitation lung function after thrombolysis treatment in a CA porcine model caused by PTE.

Methods: After 2 min of untreated CA, pigs of 10-12 weeks with a weight of 30 ± 2 kg (n = 24) were treated with recombinant human tissue plasminogen activator (50 mg). Cardiopulmonary resuscitation (CPR) and ventilation were initiated after drug administration. Pulmonary function and arterial blood gas parameters were measured at baseline, return of spontaneous circulation (ROSC) immediately, and 1 h, 2 h, 4 h, and 6 h after ROSC.

Results: The dynamic lung compliance decreased significantly at ROSC immediately and 1 h after ROSC compared to baseline (21.86 ± 2.00 vs. 26.72 ± 2.20 ml/mmHg and 20.38 ± 1.31 vs. 26.72 ± 2.20 ml/mmHg, respectively; P < 0.05; 1 mmHg = 0.133 kPa). Compared with baseline, airway resistance increased significantly at ROSC immediately and 1 h after ROSC (P < 0.05). Respiratory index also increased after ROSC and showed significant differences among baseline, ROSC immediately, and 2 h after ROSC (P < 0.05). Oxygen delivery decreased at ROSC immediately compared to baseline (P < 0.05). The oxygenation index decreased significantly at any time after ROSC compared to baseline (P < 0.05). Extravascular lung water index and pulmonary vascular permeability index (PVPI) showed significant differences at ROSC immediately compared to baseline and 1 h after ROSC (P < 0.05); PVPI at ROSC immediately was also different from 6 h after ROSC (P < 0.05). Ventilation/perfusion ratios increased after ROSC (P < 0.05). Histopathology showed fibrin effusion, bleeding in alveoli, and hemagglutination in pulmonary artery.

Conclusions: Lung function remains abnormal even after CPR with thrombolysis therapy; it is essential to continue anticoagulation and symptomatic treatment after ROSC.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Lung ventilation/perfusion scans in pigs. (a) Ventilation image at baseline. (b) Perfusion image at baseline. (c) Ventilation image at 4 h after ROSC. (d) Perfusion image at 4 h after ROSC. ROSC: Return of spontaneous circulation.
Figure 2
Figure 2
The variation of ventilation/perfusion ratio of pigs at baseline and postresuscitation. *P < 0.05 versus baseline, †P < 0.05 versus ROSC. V/Q: Ventilation/perfusion ratio; ROSC: Return of spontaneous circulation.
Figure 3
Figure 3
Specimen and histopathology of the lung of pigs (HE staining, ×400). (a) Pulmonary specimen, lung infarction. (b) Pig without CA caused by PTE. (c) Postresuscitation of CA pig caused by PTE. ① Fibrin effusion and bleeding in alveoli. ② Bleeding and inflammatory cell infiltration in interalveolar septum. CA: Cardiac arrest; PTE: Pulmonary thromboembolism.
See this image and copyright information in PMC

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