Effects of intravenous fluid type on cerebral perfusion pressure during cardiopulmonary resuscitation in porcine experimental cardiac arrest model

Introduction Fluid resuscitation is important to maintain organ perfusion which is essential for clinical outcomes in out-of-hospital cardiac arrest (OHCA). The purpose of this experimental study is to evaluate the association between type of intravenous fluid management and cerebral perfusion pressure (CePP). Material & Method Ventricular fibrillation cardiac arrest model for 12 pigs were designed and conducted. Study protocol aimed to simulate OHCA cardiopulmonary resuscitation (CPR) by bystander and advanced emergency medical service (EMS) providers. Three types of intravenous fluid (Crystalloid: 0.9 % NaCl 1cc/kg/min, Colloid: 3 % NaCl 0.5cc/kg/ min and minimal fluid) were assigned to administer after 8. physiologic parameters including CePP were collected and calculated. A paired t-test was used to evaluate the change according to the progress of cardiac arrest. Result After 18-minutes of infusion, Crystalloid group showed highest MAP and ICP among all study groups: median (IQR) in Minimal : 6 (4) mmHg, Crystalloid : 12.8 (1.4) mmHg, Colloid : 11 (12) mmHg for MAP, and Minimal : 7.4 (33.5) mmHg, Crystalloid : 12.8 (1.4) mmHg, Colloid : 3.2 (19.9) mmHg for ICP. Colloid group showed higher CePP since intravenous fluid infused. reduction of CePP compared to initial CPR phase, showed steeper and deeper in crystalloid. Conclusion We found that intravenous crystalloid administration was associated with rapid and deeper reduction of CePP during CPR compared to colloid or resuscitation without fluid management. Colloid group showed higher CePP in most phases after fluid infusion, compared to the other study groups.