Intravenous calcium as a pressor in a swine model of hypoxic pseudo-pulseless electrical mechanical activity—a preliminary report
Abstract Background Pseudo-pulseless electrical activity (pseudo-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical activity without clinically detectable pulses. Pseudo-PEA may constitute up to 40% of reported cases of cardiac arrest. Resuscitation from...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2020-09-01
|
| Series: | Intensive Care Medicine Experimental |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40635-020-00340-0 |
| _version_ | 1828348710580387840 |
|---|---|
| author | Alexander L. Lindqwister Joshua W. Lampe Jeffrey R. Gould Christopher L. Kaufman Karen L. Moodie Norman A. Paradis |
| author_facet | Alexander L. Lindqwister Joshua W. Lampe Jeffrey R. Gould Christopher L. Kaufman Karen L. Moodie Norman A. Paradis |
| author_sort | Alexander L. Lindqwister |
| collection | DOAJ |
| description | Abstract Background Pseudo-pulseless electrical activity (pseudo-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical activity without clinically detectable pulses. Pseudo-PEA may constitute up to 40% of reported cases of cardiac arrest. Resuscitation from pseudo-PEA is often associated with hypotension refractory to catecholamine pressors. We hypothesized that this post-resuscitation state may be associated with hypocalcemic hypotension responsive to intravenous calcium. Methods Using pre-existing data from our hypoxic swine pseudo-PEA model, we measured blood pressure, hemodynamics, and electrolytes. Physiological data were analyzed on a heartbeat by heartbeat basis. The midpoint of the calcium response was defined using change of curvature feature detection. Hemodynamic parameters were shifted such that the value at the midpoint was equal to zero. Results In 9 animals with refractory hypotension, we administered 37 boluses of intravenous calcium in the dosage range of 5-20 mg. Comparisons were made between the average values in the time period 40-37 s before the midpoint and 35-40 s after the midpoint. Of the 37 administered boluses, 34 manifested a change in the blood pressure, with mean aortic pressure, systolic and diastolic pressures all increasing post bolus administration. Conclusions Administration of intravenous calcium may be associated with a pressor-like response in refractory hypotension after resuscitation from pseudo-PEA. Relative ionized hypocalcemia may cause hypotension after resuscitation from pseudo-PEA. Therapy with intravenous calcium should be further investigated in this setting. |
| first_indexed | 2024-04-14T00:58:34Z |
| format | Article |
| id | doaj.art-96bc47ce139d43a28d0a270209f7855c |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-04-14T00:58:34Z |
| publishDate | 2020-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-96bc47ce139d43a28d0a270209f7855c2022-12-22T02:21:30ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2020-09-018111310.1186/s40635-020-00340-0Intravenous calcium as a pressor in a swine model of hypoxic pseudo-pulseless electrical mechanical activity—a preliminary reportAlexander L. Lindqwister0Joshua W. Lampe1Jeffrey R. Gould2Christopher L. Kaufman3Karen L. Moodie4Norman A. Paradis5Geisel School of Medicine, Dartmouth CollegeZOLL Medical CorpZOLL Medical CorpZOLL Medical CorpGeisel School of Medicine, Dartmouth CollegeGeisel School of Medicine, Dartmouth CollegeAbstract Background Pseudo-pulseless electrical activity (pseudo-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical activity without clinically detectable pulses. Pseudo-PEA may constitute up to 40% of reported cases of cardiac arrest. Resuscitation from pseudo-PEA is often associated with hypotension refractory to catecholamine pressors. We hypothesized that this post-resuscitation state may be associated with hypocalcemic hypotension responsive to intravenous calcium. Methods Using pre-existing data from our hypoxic swine pseudo-PEA model, we measured blood pressure, hemodynamics, and electrolytes. Physiological data were analyzed on a heartbeat by heartbeat basis. The midpoint of the calcium response was defined using change of curvature feature detection. Hemodynamic parameters were shifted such that the value at the midpoint was equal to zero. Results In 9 animals with refractory hypotension, we administered 37 boluses of intravenous calcium in the dosage range of 5-20 mg. Comparisons were made between the average values in the time period 40-37 s before the midpoint and 35-40 s after the midpoint. Of the 37 administered boluses, 34 manifested a change in the blood pressure, with mean aortic pressure, systolic and diastolic pressures all increasing post bolus administration. Conclusions Administration of intravenous calcium may be associated with a pressor-like response in refractory hypotension after resuscitation from pseudo-PEA. Relative ionized hypocalcemia may cause hypotension after resuscitation from pseudo-PEA. Therapy with intravenous calcium should be further investigated in this setting.http://link.springer.com/article/10.1186/s40635-020-00340-0PressorCalciumPEAPulseless electrical activity |
| spellingShingle | Alexander L. Lindqwister Joshua W. Lampe Jeffrey R. Gould Christopher L. Kaufman Karen L. Moodie Norman A. Paradis Intravenous calcium as a pressor in a swine model of hypoxic pseudo-pulseless electrical mechanical activity—a preliminary report Intensive Care Medicine Experimental Pressor Calcium PEA Pulseless electrical activity |
| title | Intravenous calcium as a pressor in a swine model of hypoxic pseudo-pulseless electrical mechanical activity—a preliminary report |
| title_full | Intravenous calcium as a pressor in a swine model of hypoxic pseudo-pulseless electrical mechanical activity—a preliminary report |
| title_fullStr | Intravenous calcium as a pressor in a swine model of hypoxic pseudo-pulseless electrical mechanical activity—a preliminary report |
| title_full_unstemmed | Intravenous calcium as a pressor in a swine model of hypoxic pseudo-pulseless electrical mechanical activity—a preliminary report |
| title_short | Intravenous calcium as a pressor in a swine model of hypoxic pseudo-pulseless electrical mechanical activity—a preliminary report |
| title_sort | intravenous calcium as a pressor in a swine model of hypoxic pseudo pulseless electrical mechanical activity a preliminary report |
| topic | Pressor Calcium PEA Pulseless electrical activity |
| url | http://link.springer.com/article/10.1186/s40635-020-00340-0 |
| work_keys_str_mv | AT alexanderllindqwister intravenouscalciumasapressorinaswinemodelofhypoxicpseudopulselesselectricalmechanicalactivityapreliminaryreport AT joshuawlampe intravenouscalciumasapressorinaswinemodelofhypoxicpseudopulselesselectricalmechanicalactivityapreliminaryreport AT jeffreyrgould intravenouscalciumasapressorinaswinemodelofhypoxicpseudopulselesselectricalmechanicalactivityapreliminaryreport AT christopherlkaufman intravenouscalciumasapressorinaswinemodelofhypoxicpseudopulselesselectricalmechanicalactivityapreliminaryreport AT karenlmoodie intravenouscalciumasapressorinaswinemodelofhypoxicpseudopulselesselectricalmechanicalactivityapreliminaryreport AT normanaparadis intravenouscalciumasapressorinaswinemodelofhypoxicpseudopulselesselectricalmechanicalactivityapreliminaryreport |