Minimal coronary stenoses and left ventricular blood flow during CPR

Karl B Kern, Gordon A. Ewy

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Study objective: To assess the effect of a 33% coronary stenosis on myocardial blood flow during normal sinus rhythm and CPR. Design: Prospective, before and after cardiac arrest and CPR; before and after creation of a 33% stenosis. Setting: The University of Arizona Resuscitation Research Laboratory. Subjects: Ten domestic closed-chest swine with patent coronary stenoses. Interventions: A Teflon® cylinder was placed in the mid-left anterior descending coronary artery to create a 33% stenosis. Myocardial blood flow was measured with colored microspheres both proximal and distal to the stenosis during normal sinus rhythm and during CPR. Measurements and main results: During normal sinus rhythm, the stenosis did not alter the amount of myocardial blood flow distribution or quantity. Proximal to the stenosis the endocardial/epicardial flow ratio was 1.49 ± 0.33, and distal to the stenosis it was 1.50 ± 0.50. Likewise, during normal sinus rhythm, blood flow proximal and distal to the stenosis did not differ for either the epicardium (79 ± 9 versus 66 ± 13 mL/min/100 g) or the endocardium (111 ± 27 versus 83 ± 19 mL/min/100 g). However, the distribution of myocardial blood flow was markedly altered during CPR. The resultant endocardial/epicardial flow ratios were significantly less than during normal sinus rhythm, 0.49 ± 0.11 (three minutes of CPR) and 0.74 ± 0.07 (eight minutes of CPR) proximal to the stenosis and 0.39 ± 0.15 (three minutes of CPR) and 0.49 ± 0.14 (eight minutes of CPR) distal to the stenosis (P <.05 versus normal sinus rhythm). In the presence of a 33% mid-left anterior descending coronary artery stenosis, endocardial blood flow at eight minutes of CPR was significantly lower distal to the stenosis compared with proximal to the stenosis (23 ± 7 mL/min/100 g versus 74 ± 18 mL/min/100 g; P < .02). Conclusion: Minimal coronary lesions that do not diminish myocardial perfusion during normal physiologic conditions appear to significantly decrease subendocardial blood flow during cardiac arrest and CPR.

Original languageEnglish (US)
Pages (from-to)1066-1072
Number of pages7
JournalAnnals of Emergency Medicine
Volume21
Issue number9
DOIs
StatePublished - 1992

Fingerprint

Coronary Stenosis
Cardiopulmonary Resuscitation
Pathologic Constriction
Heart Arrest
Endocardium
Pericardium
Polytetrafluoroethylene
Microspheres
Resuscitation
Coronary Vessels
Swine
Thorax
Perfusion

Keywords

  • coronary stenoses
  • CPR

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Minimal coronary stenoses and left ventricular blood flow during CPR. / Kern, Karl B; Ewy, Gordon A.

In: Annals of Emergency Medicine, Vol. 21, No. 9, 1992, p. 1066-1072.

Research output: Contribution to journalArticle

@article{dda5f3501dea46b5a5209178cf569284,
title = "Minimal coronary stenoses and left ventricular blood flow during CPR",
abstract = "Study objective: To assess the effect of a 33{\%} coronary stenosis on myocardial blood flow during normal sinus rhythm and CPR. Design: Prospective, before and after cardiac arrest and CPR; before and after creation of a 33{\%} stenosis. Setting: The University of Arizona Resuscitation Research Laboratory. Subjects: Ten domestic closed-chest swine with patent coronary stenoses. Interventions: A Teflon{\circledR} cylinder was placed in the mid-left anterior descending coronary artery to create a 33{\%} stenosis. Myocardial blood flow was measured with colored microspheres both proximal and distal to the stenosis during normal sinus rhythm and during CPR. Measurements and main results: During normal sinus rhythm, the stenosis did not alter the amount of myocardial blood flow distribution or quantity. Proximal to the stenosis the endocardial/epicardial flow ratio was 1.49 ± 0.33, and distal to the stenosis it was 1.50 ± 0.50. Likewise, during normal sinus rhythm, blood flow proximal and distal to the stenosis did not differ for either the epicardium (79 ± 9 versus 66 ± 13 mL/min/100 g) or the endocardium (111 ± 27 versus 83 ± 19 mL/min/100 g). However, the distribution of myocardial blood flow was markedly altered during CPR. The resultant endocardial/epicardial flow ratios were significantly less than during normal sinus rhythm, 0.49 ± 0.11 (three minutes of CPR) and 0.74 ± 0.07 (eight minutes of CPR) proximal to the stenosis and 0.39 ± 0.15 (three minutes of CPR) and 0.49 ± 0.14 (eight minutes of CPR) distal to the stenosis (P <.05 versus normal sinus rhythm). In the presence of a 33{\%} mid-left anterior descending coronary artery stenosis, endocardial blood flow at eight minutes of CPR was significantly lower distal to the stenosis compared with proximal to the stenosis (23 ± 7 mL/min/100 g versus 74 ± 18 mL/min/100 g; P < .02). Conclusion: Minimal coronary lesions that do not diminish myocardial perfusion during normal physiologic conditions appear to significantly decrease subendocardial blood flow during cardiac arrest and CPR.",
keywords = "coronary stenoses, CPR",
author = "Kern, {Karl B} and Ewy, {Gordon A.}",
year = "1992",
doi = "10.1016/S0196-0644(05)80646-8",
language = "English (US)",
volume = "21",
pages = "1066--1072",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "9",

}

TY - JOUR

T1 - Minimal coronary stenoses and left ventricular blood flow during CPR

AU - Kern, Karl B

AU - Ewy, Gordon A.

PY - 1992

Y1 - 1992

N2 - Study objective: To assess the effect of a 33% coronary stenosis on myocardial blood flow during normal sinus rhythm and CPR. Design: Prospective, before and after cardiac arrest and CPR; before and after creation of a 33% stenosis. Setting: The University of Arizona Resuscitation Research Laboratory. Subjects: Ten domestic closed-chest swine with patent coronary stenoses. Interventions: A Teflon® cylinder was placed in the mid-left anterior descending coronary artery to create a 33% stenosis. Myocardial blood flow was measured with colored microspheres both proximal and distal to the stenosis during normal sinus rhythm and during CPR. Measurements and main results: During normal sinus rhythm, the stenosis did not alter the amount of myocardial blood flow distribution or quantity. Proximal to the stenosis the endocardial/epicardial flow ratio was 1.49 ± 0.33, and distal to the stenosis it was 1.50 ± 0.50. Likewise, during normal sinus rhythm, blood flow proximal and distal to the stenosis did not differ for either the epicardium (79 ± 9 versus 66 ± 13 mL/min/100 g) or the endocardium (111 ± 27 versus 83 ± 19 mL/min/100 g). However, the distribution of myocardial blood flow was markedly altered during CPR. The resultant endocardial/epicardial flow ratios were significantly less than during normal sinus rhythm, 0.49 ± 0.11 (three minutes of CPR) and 0.74 ± 0.07 (eight minutes of CPR) proximal to the stenosis and 0.39 ± 0.15 (three minutes of CPR) and 0.49 ± 0.14 (eight minutes of CPR) distal to the stenosis (P <.05 versus normal sinus rhythm). In the presence of a 33% mid-left anterior descending coronary artery stenosis, endocardial blood flow at eight minutes of CPR was significantly lower distal to the stenosis compared with proximal to the stenosis (23 ± 7 mL/min/100 g versus 74 ± 18 mL/min/100 g; P < .02). Conclusion: Minimal coronary lesions that do not diminish myocardial perfusion during normal physiologic conditions appear to significantly decrease subendocardial blood flow during cardiac arrest and CPR.

AB - Study objective: To assess the effect of a 33% coronary stenosis on myocardial blood flow during normal sinus rhythm and CPR. Design: Prospective, before and after cardiac arrest and CPR; before and after creation of a 33% stenosis. Setting: The University of Arizona Resuscitation Research Laboratory. Subjects: Ten domestic closed-chest swine with patent coronary stenoses. Interventions: A Teflon® cylinder was placed in the mid-left anterior descending coronary artery to create a 33% stenosis. Myocardial blood flow was measured with colored microspheres both proximal and distal to the stenosis during normal sinus rhythm and during CPR. Measurements and main results: During normal sinus rhythm, the stenosis did not alter the amount of myocardial blood flow distribution or quantity. Proximal to the stenosis the endocardial/epicardial flow ratio was 1.49 ± 0.33, and distal to the stenosis it was 1.50 ± 0.50. Likewise, during normal sinus rhythm, blood flow proximal and distal to the stenosis did not differ for either the epicardium (79 ± 9 versus 66 ± 13 mL/min/100 g) or the endocardium (111 ± 27 versus 83 ± 19 mL/min/100 g). However, the distribution of myocardial blood flow was markedly altered during CPR. The resultant endocardial/epicardial flow ratios were significantly less than during normal sinus rhythm, 0.49 ± 0.11 (three minutes of CPR) and 0.74 ± 0.07 (eight minutes of CPR) proximal to the stenosis and 0.39 ± 0.15 (three minutes of CPR) and 0.49 ± 0.14 (eight minutes of CPR) distal to the stenosis (P <.05 versus normal sinus rhythm). In the presence of a 33% mid-left anterior descending coronary artery stenosis, endocardial blood flow at eight minutes of CPR was significantly lower distal to the stenosis compared with proximal to the stenosis (23 ± 7 mL/min/100 g versus 74 ± 18 mL/min/100 g; P < .02). Conclusion: Minimal coronary lesions that do not diminish myocardial perfusion during normal physiologic conditions appear to significantly decrease subendocardial blood flow during cardiac arrest and CPR.

KW - coronary stenoses

KW - CPR

UR - http://www.scopus.com/inward/record.url?scp=0026767472&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026767472&partnerID=8YFLogxK

U2 - 10.1016/S0196-0644(05)80646-8

DO - 10.1016/S0196-0644(05)80646-8

M3 - Article

VL - 21

SP - 1066

EP - 1072

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 9

ER -