Sodium Nitroprusside–Enhanced Cardiopulmonary Resuscitation Improves Blood Flow by Pulmonary Vasodilation Leading to Higher Oxygen Requirements

• Main Authors: Adrian Ripeckyj, BA, Marinos Kosmopoulos, MD, Kadambari Shekar, MS, Claire Carlson, DO, Rajat Kalra, MD, Jennifer Rees, PhD, Tom P. Aufderheide, MD, MS, Jason A. Bartos, MD, PhD, Demetris Yannopoulos, MD
• Format: Article
• Language: English
• Published: Elsevier 2020-02-01
• Series: JACC: Basic to Translational Science
• Online Access: http://www.sciencedirect.com/science/article/pii/S2452302X19304103
• ISSN: 2452-302X

Summary: Sodium nitroprusside–enhanced cardiopulmonary resuscitation has shown superior resuscitation rates and neurologic outcomes in large animal models supporting the need for a randomized human clinical trial. This study is the first to show nonselective pulmonary vasodilation as a potential mechanism for the hemodynamic benefits. The pulmonary shunting that is created requires increased oxygen treatment, but the overall improvement in blood flow increases minute oxygen delivery to tissues. In this context, hypoxemia is an important safety endpoint and a 100% oxygen ventilation strategy may be necessary for the first human clinical trial. Key Words: cardiopulmonary resuscitation, coronary perfusion pressure, lactic acid, pulmonary vasodilation, sodium nitroprusside