Comparison between active abdominal compression-decompression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation in asphyctic cardiac arrest rats with multiple rib fractures

Abstract

Abstract Background Active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) is potentially more effective for cardiac arrest with multiple rib fractures. However, its impact on survival rates and neurological outcomes remains unknown. This study aimed to assess if AACD-CPR improves survival rates and neurological outcomes in a rat model of asphyctic cardiac arrest with multiple rib fractures. Methods Adult male Sprague-Dawley rats were randomized into 3 groups: AACD group (n = 15), standard cardiopulmonary resuscitation (STD-CPR) group (n = 15), and sham group (n = 10), after bilateral rib fractures were surgically created and endotracheal intubation was performed. AACD-CPR and STD-CPR groups underwent 8 minutes of asphyxia followed by different CPR techniques. The sham group had venous catheterization only. Physiological variables and arterial blood gases were recorded at baseline and during a 4-hour monitoring period. Neurological deficit scores (NDS) and cumulative survival rates were assessed at 24 h, 48 h, and 72 h. NDS, serum biomarkers and hippocampal neuron analysis were used to evaluate neurological outcomes. Results No statistical differences were observed in the return of spontaneous circulation (ROSC), 24-hour, 48-hour, and 72-hour survival rates between the AACD-CPR and STD-CPR groups. AACD-CPR rats had lower serum levels of neuron-specific enolase (NSE) and S100B at 72 hours post-ROSC, and higher NDS at 72 hours post-ROSC compared to STD-CPR animals. Cellular morphology analysis, H&E staining, and TUNEL/DAPI assays showed more viable neurons and fewer apoptotic neurons in the AACD-CPR group than in the STD-CPR group. Conclusions AACD-CPR can achieve similar survival rates and better neurologic outcome after asphyxial cardiac arrest in rats with multiple rib fractures when compared to STD-CPR.