Quality chest compressions during Cardiopulmonary Resuscitation (CPR) are vital to maintaining adequate perfusion of oxygenated blood to the organs of the body to sustain life. Over the years, the compression rate recommended in Basic Life Support (BLS)/ Advanced Cardiac Life Support (ACLS) protocols for the best possible outcome has risen, and with that increase there are questions regarding rescuer fatigue and the effectiveness of compressions. Layperson and professional rescuers, answering to an emergency, both maintain continuous chest compressions until advanced life support arrives. Depending on the location, this arrival time would most likely be longer than the two minute standard time given to rotate rescuers before fatigue compromises performance. The objective of this research was to investigate the level of rescuer fatigue associated with continuous compressions, varying compression rates, physical fitness, gender, and among layperson versus professional rescuers. Sixty-one participants performed uninterrupted chest compressions on a manikin for 15 minutes. Before performing compressions, physical fitness was evaluated using a YMCA bench press for an assessment of upper body strength/endurance and a 3-minute step test to evaluate aerobic fitness. Subjects performed two trials at compression rates of greater or equal to 80 and greater or equal to 100 per minute with a 5-minute rest between trials. Male professional rescuers had a greater strength/endurance, and thus were able to perform compressions for a longer period of time compared to their female counterparts. Compression duration and the YMCA Bench Press test score were significantly correlated (p = .0135). Cardiocerebral Resuscitation providers should maintain an adequate upper body strength, particularly if they may be required to perform continuous chest compressions at high rates for more than a few minutes.

It is a major clinical problem that survival rates after out-of-hospital cardiac arrest have not markedly improved during the last decades, despite extensive research and the introduction of new interventions. However, recent studies have demonstrated promising treatments such as targeted temperature management (TTM) and methylene blue (MB). In our first study, we investigated the effect of MB administered during experi-mental cardiopulmonary resuscitation (CPR) in the setting of postponed hypother-mia in piglets. We set out to study if MB could compensate for a delay to establish targeted TTM. The study demonstrated that MB more than compensated for 30 min delay in induction of TTM. The effect of MB added to that of TTM. The second study examined the effects of TTM and S-PBN on the endothelin system and nitric oxide synthases (NOS) after prolonged CA in a porcine CPR mod-el. The study was designed to understand the cardioprotective mechanism of S-PBN and TTM by their influence on the endothelin system and NOS regulation. We veri-fied for the first time, that these two cardioprotective postresuscitative interventions activate endothelin-1 and its receptors concomitantly with eNOS and nNOS in the myocardium. We concluded that nitric oxide and endothelin pathways are implicated in the postresuscitative cardioprotective effects of TTM. The third study compared survival and hemodynamic effects of low-dose amio-darone and vasopressin to vasopressin in a porcine hypovolemic CA model. The study was designed to evaluate whether resuscitation with amiodarone and vasopressin compared to vasopressin alone would have an impact on resuscitation success, survival, and hemodynamic parameters after hemorrhagic CA. We found that combined resuscitation with amiodarone and vasopressin after hemorrhagic circulatory arrest resulted in greater 3-hour survival, better preserved hemodynamic parameters and smaller myocardial injury compared to resuscitation with vasopressin only. In our fourth study we planned to compare hemodynamic parameters between the treatment group (milrinone, esmolol and vasopressin; MEV) and control group (vasopressin only) during resuscitation from prolonged cardiac arrest in piglets. The study was designed to demonstrate if MEV treatment improved hemodynamics or cardiac damage compared to controls. We demonstrated that MEV treatment reduced cardiac injury compared with vasopressin alone.