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Wanchun Tang - One of the best experts on this subject based on the ideXlab platform.

  • Correlation of end tidal carbon dioxide, amplitude spectrum area, and Coronary Perfusion Pressure in a porcine model of cardiac arrest
    Physiological Reports, 2017
    Co-Authors: Nicolas Segal, Wanchun Tang, Anja Metzger, Johanna C. Moore, Laura India, Michael Lick, Paul S. Berger, David G. Benditt, Keith G. Lurie
    Abstract:

    Abstract Amplitude Spectrum Area (AMSA) values during ventricular fibrillation (VF) correlate with myocardial energy stores and predict defibrillation success. By contrast, end tidal CO 2 (ETCO2) values provide a noninvasive assessment of Coronary Perfusion Pressure and myocardial Perfusion during cardiopulmonary resuscitation (CPR). Given the importance of the timing of defibrillation shock delivery on clinical outcome, we tested the hypothesis that AMSA and ETCO2 correlate with each other and can be used interchangably to correlate with myocardial Perfusion in an animal laboratory preclinical, randomized, prospective investigation. After 6 min of untreated VF, 12 female pigs (32 ± 1 Kg), isoflurane anesthetized pigs received sequentially 3 min periods of standard (S) CPR, S‐CPR+ an impedance threshold device (ITD), and then active compression decompression (ACD) + ITD CPR. Hemodynamic, AMSA, and ETCO2 measurements were made with each method of CPR. The Spearman correlation and Friedman tests were used to compare hemodynamic parameters. ETCO2, AMSA, Coronary Perfusion Pressure, cerebral Perfusion Pressure were lowest with STD CPR, increased with STD CPR + ITD and highest with ACD CPR + ITD. Further analysis demonstrated a positive correlation between AMSA and ETCO2 ( r  = 0.37, P  = 0.025) and between AMSA and key hemodynamic parameters ( P

  • abstract 138 effects of compression rate on Coronary Perfusion Pressure and carotid blood flow in a porcine model of shock induced pulseless electrical activity
    Circulation, 2012
    Co-Authors: Weilun Quan, Yinlun Weng, Shijie Sun, Wei Chen, Wanchun Tang
    Abstract:

    Background: The 2010 AHA guidelines recommend a chest compression (CC) depth of at least 2 inches. However, most clinical studies found an inverse association between CC depth and rate. The effect of CC rate on Coronary Perfusion Pressure (CPP) and carotid blood flow (CBF) has not been determined. This study was to investigate hemodynamic responses to CC at different compression rate in a post- shock PEA porcine model. Methods: Ventricular fibrillation was electrically induced and untreated for 2 - 7 mins in 12 domestic pigs weighing 22-24kg. Post- shock PEA was induced with electric shock. Peak aortic Pressures below 40 mm Hg was used to identify a qualified PEA. Once PEA was induced, animals received 30 sec PEA-triggered synchronized sternal CC using a modified Thumper device. CC depth was maintained at 2 inches. If animals were resuscitated after the study sequence PEA induction and the study sequence were repeated after 30 mins recovery. Results: A total of 1102 compression cycles from 29 qualified PEA events were included in the analyses. The rate of induced PEA varied from 30 to 125 bpm. When the CC rate increased from 80 to 120 bpm with fixed CC depth, CPP increased by 5.6 mmHg (32.9%) and CBF increased by 46.4 ml/min (50.2%). Both CPP and CBF were positively correlated to CC rate with correlation coefficients of 0.32 and 0.49 (p=0), respectively. Linear regression found a positive trend for both CPP and CBF with slopes over the CC rate of 0.14 and 1.16 (p=0), respectively. Conclusions: In this shock induced PEA porcine model, both CPP and CBF increased with CC rate. These results indicate that faster sternal CC would generate better Coronary and cerebral Perfusion in the range between 80 to 120 bpm.

  • Abstract 179: The Comparison of the Effect of Two Mechanical Chest Compressors on Coronary Perfusion Pressure and Outcomes of CPR With Selective Head Cooling
    Circulation, 2010
    Co-Authors: Yinlun Weng, Max Harry Weil, Sungphil Chung, Jeonghyun Park, Shijie Sun, Wanchun Tang
    Abstract:

    Selective head cooling has been confirmed to improve the Coronary Perfusion Pressure (CPP) during CPR. Mechanical chest compressors have been utilized to improve resuscitation after cardiac arrest....

  • Abstract 180: The Comparison of the Effect of Two Mechanical Chest Compressors on Coronary Perfusion Pressure and Resuscitation Outcome During CPR
    Circulation, 2010
    Co-Authors: Yinlun Weng, Max Harry Weil, Sungphil Chung, Jeonghyun Park, Shijie Sun, Wanchun Tang
    Abstract:

    Life-sustaining Coronary blood flow could be created through effective chest compressions. The mechanical chest compressors have been utilized to improve resuscitation after cardiac arrest. In this study, we compared the effect of the ThumperTM compressor and the LucasTM, active compression-decompression devices, on Coronary Perfusion Pressure (CPP) in a swine model of CPR. We hypothesized that the LucasTM device would achieve better CPP and therefore favor the outcome of CPR. Ventricular fibrillation (VF) was induced and untreated for 10mins in 9 male swine weighing 40±3kg. CPR was initiated using the LucasTM compressor in 4 animals and the ThumperTM compressor in 5 animals. Epinephrine (30 mg/kg) was injected intravenously at the 2nd minute of compression. Defibrillation was attempted after 5mins of CPR. If return of spontaneous circulation (ROSC) was not achieved, CPR was continued for 1min prior to a subsequent defibrillation attempt until ROSC or for a total of 15mins. CPP was continuously monitored....

  • abstract p51 nasopharyngeal cooling improves Coronary Perfusion Pressure and amplitude spectrum area during cpr in comparison to systemic cold saline infusion in a porcine model of prolonged cardiac arrest
    Circulation, 2009
    Co-Authors: Giuseppe Ristagno, Max Harry Weil, Wanchun Tang
    Abstract:

    P51: Nasopharyngeal Cooling Improves Coronary Perfusion Pressure and Amplitude Spectrum Area During CPR in Comparison to Systemic Cold Saline Infusion in a Porcine Model of Prolonged Cardiac Arrest Tao Yu; Giuseppe Ristagno; Yongqin Li; Max H Weil; Wanchun Tang 1 Weil Institute of Critical Care Medicine, the Second Affiliated Hosp of Sun Yat-sen Univ, Rancho Mirage, CA 2 Weil Institute of Critical Care Medicine, Rancho Mirage, CA 3 Weil Institute of Critical Care Medicine, the Second Affiliated Hosp of Sun Yat-sen Univ, Rancho Mirage, CA 4 Weil Institute of Critical Care Medicine, Keck Sch of Medicine of the Univ of Southern California, Rancho Mirage, CA Background We have previously demonstrated that nasopharyngeal cooling (NPC) initiated during CPR improves the success of resuscitation. In the present study, we compared the effects of NPC with cold saline infusion (CSI) on hemodynamics, amplitude spectrum area (AMSA) during CPR and ultimate resuscitation outcome in a porcine model of prolonged cardiac arrest. We hypothesized that NPC would yield better resuscitation outcome when compared to CSI when both were initiated during CPR. Methods Ventricular fibrillation (VF) was induced in 14 pigs weighing 38±2 kg. After 15 minutes of untreated VF, CPR was performed for 5 minutes prior to defibrillation. Coincident with the start of CPR, animals were randomized to receive NPC with the aid of the RhinoChill Device or CSI with 30 mL/kg 4°C saline. One hour after ROSC, surface cooling with the aid of a water blanket was begun in both groups and maintained at 35.4°C for 4 hours. Results During CPR, jugular vein temperature was significantly decreased in animals subjected to NPC in comparison to those receiving CSI (P<0.01). Core temperature, however, was decreased only in animals receiving CSI (P<0.01). Coronary Perfusion Pressure was significantly greater in the animals treated with NPC (P=0.02). AMSA values in NPC group was significantly higher than CSI group (P=0.03). All 7 animals treated with NPC were successfully resuscitated in contrast to only 2 in the CSI group (P=0.02). Conclusion In this model, NPC improved hemodynamics and AMSA during CPR and this was associated with increases in the success of resuscitation.

Stig Steen - One of the best experts on this subject based on the ideXlab platform.

  • phase controlled intermittent intratracheal insufflation of oxygen during chest compression active decompression mcpr improves Coronary Perfusion Pressure over continuous insufflation
    Resuscitation, 2019
    Co-Authors: Kristian Soltesz, Audrius Paskevicius, Henry Pigot, Qiuming Liao, Trygve Sjoberg, Stig Steen
    Abstract:

    Purpose: It has previously been shown that continuous intratracheal insufflation of oxygen (CIO) is superior to intermittent positive Pressure ventilation (IPPV) regarding gas exchange and haemodynamics. The purpose of this study was to investigate gas exchanged and haemodynamics with a new technique of phase-controlled intermittent insufflation of oxygen (PIIO) compared to CIO. Method: Twenty (20) pigs were used, stratified into two groups (CIO, PIIO), with 10 animals each. Upon induction of ventricular fibrillation, standard ventilator support was replaced by either of CIO or PIIO ventilation. Chest compressions were delivered by the LUCAS I mCPR device. Following 20 min of CPR in normothermia, defibrillation was attempted. Results: Return of spontaneous circulation (ROSC) occurrence was not significantly higher (P<0.16) in the PIIO (9/10) than in the CIO (6/10) group. During the decompression phase the PIIO group showed significant increases in mean (P<0.01), maximal (P<0.02) and end-decompression (P<0.01) Coronary Perfusion Pressure (CPP), compared to the CIO group. PIIO resulted in increased compression phase aortic Pressure (P<0.03). Intratracheal Pressure was 5–30 cmH2O within both groups during mCPR, with a significantly lower (P<0.02) mean for the PIIO group. Arterial and venous blood gas analysis showed comparable results between the groups, when taking base line values into account. An exception was that PIIO resulted in significantly higher (P<0.05) oxygen partial Pressure during mCPR, and lower (P<0.05) arterial lactate following ROSC. Conclusion: PIIO results in significantly higher CPP and compression phase aortic Pressure during mCPR in a porcine population. Further studies are needed to validate these findings in humans. (Less)

  • The effects of epinephrine/norepinephrine on end-tidal carbon dioxide concentration, Coronary Perfusion Pressure and pulmonary arterial blood flow during cardiopulmonary resuscitation
    Resuscitation, 2000
    Co-Authors: Lars Lindberg, Quiming Liao, Stig Steen
    Abstract:

    End-tidal CO2 concentration correlates with pulmonary blood flow during cardiopulmonary resuscitation and has been claimed to be a useful tool to judge the effectiveness of chest compression. A high concentration of end-tidal CO2 has been related to a better outcome. However, most authors have noticed a decrease in end-tidal CO2 concentration after administration of epinephrine, concomitant with an increase in Coronary Perfusion Pressure and an increased incidence of return of spontaneous circulation. This study was performed to evaluate changes in end-tidal CO2 concentration after injection of vasopressors during cardiopulmonary resuscitation and to investigate the time-course of the response and possible explanations for it. After 1 min of electrically induced cardiac arrest and 5 min of chest compressions, 18 pigs were randomly assigned to receive 0.045 mg kg(-1) epinephrine, 0.045 mg kg(-1) norepinephrine or no drug. After another 4 min of chest compressions the pigs were defibrillated. End-tidal CO2, pulmonary blood flow and Coronary Perfusion Pressure decreased immediately after the induction of cardiac arrest, increased slightly during chest compressions and increased initially to supernormal levels after the return of spontaneous circulation. Injection of epinephrine or norepinephrine during chest compressions decreased end-tidal CO2 51 +/- 2%, (mean +/- S.E.M.), and 43 +/- 1%, respectively, and pulmonary blood flow by 134 +/- 13 and 125 +/- 16%, respectively, within 1 min, simultaneously increasing Coronary Perfusion Pressure from 10 +/- 2 to 45 +/- 5 mm Hg and from 11 +/- 1 to 38 +/- 5 mm Hg, respectively. The Coronary Perfusion Pressure slowly fell, but the effects on end-tidal CO2 and pulmonary blood flow were prolonged. In conclusion, vasopressors increased Coronary Perfusion Pressure and the likelihood of a return of spontaneous circulation, but decreased end-tidal CO2 concentration and induced a critical deterioration in cardiac output and thus oxygen delivery in this model of cardiopulmonary resuscitation.

  • the effects of epinephrine norepinephrine on end tidal carbon dioxide concentration Coronary Perfusion Pressure and pulmonary arterial blood flow during cardiopulmonary resuscitation
    Resuscitation, 2000
    Co-Authors: Lars Lindberg, Quiming Liao, Stig Steen
    Abstract:

    End-tidal CO2 concentration correlates with pulmonary blood flow during cardiopulmonary resuscitation and has been claimed to be a useful tool to judge the effectiveness of chest compression. A high concentration of end-tidal CO2 has been related to a better outcome. However, most authors have noticed a decrease in end-tidal CO2 concentration after administration of epinephrine, concomitant with an increase in Coronary Perfusion Pressure and an increased incidence of return of spontaneous circulation. This study was performed to evaluate changes in end-tidal CO2 concentration after injection of vasopressors during cardiopulmonary resuscitation and to investigate the time-course of the response and possible explanations for it. After 1 min of electrically induced cardiac arrest and 5 min of chest compressions, 18 pigs were randomly assigned to receive 0.045 mg kg(-1) epinephrine, 0.045 mg kg(-1) norepinephrine or no drug. After another 4 min of chest compressions the pigs were defibrillated. End-tidal CO2, pulmonary blood flow and Coronary Perfusion Pressure decreased immediately after the induction of cardiac arrest, increased slightly during chest compressions and increased initially to supernormal levels after the return of spontaneous circulation. Injection of epinephrine or norepinephrine during chest compressions decreased end-tidal CO2 51 +/- 2%, (mean +/- S.E.M.), and 43 +/- 1%, respectively, and pulmonary blood flow by 134 +/- 13 and 125 +/- 16%, respectively, within 1 min, simultaneously increasing Coronary Perfusion Pressure from 10 +/- 2 to 45 +/- 5 mm Hg and from 11 +/- 1 to 38 +/- 5 mm Hg, respectively. The Coronary Perfusion Pressure slowly fell, but the effects on end-tidal CO2 and pulmonary blood flow were prolonged. In conclusion, vasopressors increased Coronary Perfusion Pressure and the likelihood of a return of spontaneous circulation, but decreased end-tidal CO2 concentration and induced a critical deterioration in cardiac output and thus oxygen delivery in this model of cardiopulmonary resuscitation.

S.o. Hwang - One of the best experts on this subject based on the ideXlab platform.

  • Analysis of relation between Coronary Perfusion Pressure and the extracted parameters from a ventricular fibrillation ECG signal
    The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2004
    Co-Authors: S.j. Jang, H.m. Seong, Y.r. Yoon, S.o. Hwang
    Abstract:

    This work presents an alternative return of spontaneous circulation (ROSC) estimate using indirectly induced presumption that Coronary Perfusion Pressure (CPP) correlates with the extracted parameter from the ventricular fibrillation (VF) ECG signal. In past studies, it is revealed that successful cardiopulmonary resuscitation (CPR) needs at least 30/spl sim/40mmHg CPP during the aortic diastolic period. In 360 segments derived from 18 test dogs with experimental cardiac arrest of cardiac cause, we analyzed the ability of 4 spectral features of VF before countershock to discriminate or not between segments that correspond to CPP. The median frequency (MF), peak frequency (PF), average segment amplitude (ASA) and maximum segment amplitude (MSA) were studied. After preprocessing the raw data acquired from the specific experimental setup and protocol, we verified CPP is a serious estimate of ROSC, and then we analyzed the extracted parameters corresponding to CPP by multiple regression. In the specific conditional frequency domain (MF: 9.42/spl sim/12.42Hz, PF: 8.71/spl sim/13.08Hz, ASA: > 0.19mV), CPP is correlated to the extracted parameter with 0.71 /spl plusmn/ 0.05 coefficient of multiple determination (R/sup 2/). The combination of MF, PF, and ASA achieved a 79.47 /spl plusmn/ 3% sensitivity and 41.67 /spl plusmn/ 4% specificity in testing.

Robert A Berg - One of the best experts on this subject based on the ideXlab platform.

  • blood Pressure and Coronary Perfusion Pressure targeted cardiopulmonary resuscitation improves 24 hour survival from ventricular fibrillation cardiac arrest
    Critical Care Medicine, 2016
    Co-Authors: Maryam Y Naim, Robert M Sutton, Stuart H Friess, George Bratinov, Utpal Bhalala, Todd J Kilbaugh, Joshua W Lampe, Vinay Nadkarni, Lance B Becker, Robert A Berg
    Abstract:

    Treatment algorithms for cardiac arrest are rescuer centric and vary little from patient to patient. The objective of this study was to determine if cardiopulmonary resuscitation-targeted to arterial blood Pressure and Coronary Perfusion Pressure rather than optimal guideline care would improve 24-hour survival in a porcine model of ventricular fibrillation cardiac arrest.Preclinical animal laboratory using female 3-month-old swine.A randomized interventional study.After induction of anesthesia and 7 minutes of untreated ventricular fibrillation, 16 female 3-month-old swine were randomized to 1) blood Pressure care: titration of chest compression depth to a systolic blood Pressure of 100 mm Hg and vasopressor dosing to maintain Coronary Perfusion Pressure of greater than 20 mm Hg or 2) guideline care: chest compression depth targeted to 51 mm and standard guideline vasopressor dosing. Animals received manual cardiopulmonary resuscitation for 10 minutes before the first defibrillation attempt and standardized postresuscitation care for 24 hours.Twenty-four-hour survival was more likely with blood Pressure care versus guideline care (0/8 vs 5/8; p < 0.03), and all survivors had normal neurologic examinations. Mean Coronary Perfusion Pressure prior to defibrillation was significantly higher with blood Pressure care (28 ± 3 vs 10 ± 6 mm Hg; p < 0.01). Chest compression depth was lower with blood Pressure care (48 ± 0.4 vs 44 ± 0.5 mm Hg; p < 0.05), and the number of vasopressor doses was higher with blood Pressure care (median, 3 [range, 1-7] vs 2 [range, 2-2]; p < 0.01).Individualized goal-directed hemodynamic resuscitation targeting systolic blood Pressure of 100 mm Hg and Coronary Perfusion Pressure of greater than 20 mm Hg improved 24-hour survival compared with guideline care in this model of ventricular fibrillation cardiac arrest.

  • Blood Pressure- and Coronary Perfusion Pressure-Targeted Cardiopulmonary Resuscitation Improves 24-Hour Survival From Ventricular Fibrillation Cardiac Arrest.
    Critical Care Medicine, 2016
    Co-Authors: Maryam Y Naim, Robert M Sutton, Stuart H Friess, George Bratinov, Utpal Bhalala, Todd J Kilbaugh, Joshua W Lampe, Lance B Becker, Vinay M. Nadkarni, Robert A Berg
    Abstract:

    OBJECTIVES Treatment algorithms for cardiac arrest are rescuer centric and vary little from patient to patient. The objective of this study was to determine if cardiopulmonary resuscitation-targeted to arterial blood Pressure and Coronary Perfusion Pressure rather than optimal guideline care would improve 24-hour survival in a porcine model of ventricular fibrillation cardiac arrest. DATA SOURCES Preclinical animal laboratory using female 3-month-old swine. STUDY SELECTION A randomized interventional study. DATA EXTRACTION After induction of anesthesia and 7 minutes of untreated ventricular fibrillation, 16 female 3-month-old swine were randomized to 1) blood Pressure care: titration of chest compression depth to a systolic blood Pressure of 100 mm Hg and vasopressor dosing to maintain Coronary Perfusion Pressure of greater than 20 mm Hg or 2) guideline care: chest compression depth targeted to 51 mm and standard guideline vasopressor dosing. Animals received manual cardiopulmonary resuscitation for 10 minutes before the first defibrillation attempt and standardized postresuscitation care for 24 hours. DATA SYNTHESIS Twenty-four-hour survival was more likely with blood Pressure care versus guideline care (0/8 vs 5/8; p < 0.03), and all survivors had normal neurologic examinations. Mean Coronary Perfusion Pressure prior to defibrillation was significantly higher with blood Pressure care (28 ± 3 vs 10 ± 6 mm Hg; p < 0.01). Chest compression depth was lower with blood Pressure care (48 ± 0.4 vs 44 ± 0.5 mm Hg; p < 0.05), and the number of vasopressor doses was higher with blood Pressure care (median, 3 [range, 1-7] vs 2 [range, 2-2]; p < 0.01). CONCLUSIONS Individualized goal-directed hemodynamic resuscitation targeting systolic blood Pressure of 100 mm Hg and Coronary Perfusion Pressure of greater than 20 mm Hg improved 24-hour survival compared with guideline care in this model of ventricular fibrillation cardiac arrest.

Giuseppe Ristagno - One of the best experts on this subject based on the ideXlab platform.

  • abstract p51 nasopharyngeal cooling improves Coronary Perfusion Pressure and amplitude spectrum area during cpr in comparison to systemic cold saline infusion in a porcine model of prolonged cardiac arrest
    Circulation, 2009
    Co-Authors: Giuseppe Ristagno, Max Harry Weil, Wanchun Tang
    Abstract:

    P51: Nasopharyngeal Cooling Improves Coronary Perfusion Pressure and Amplitude Spectrum Area During CPR in Comparison to Systemic Cold Saline Infusion in a Porcine Model of Prolonged Cardiac Arrest Tao Yu; Giuseppe Ristagno; Yongqin Li; Max H Weil; Wanchun Tang 1 Weil Institute of Critical Care Medicine, the Second Affiliated Hosp of Sun Yat-sen Univ, Rancho Mirage, CA 2 Weil Institute of Critical Care Medicine, Rancho Mirage, CA 3 Weil Institute of Critical Care Medicine, the Second Affiliated Hosp of Sun Yat-sen Univ, Rancho Mirage, CA 4 Weil Institute of Critical Care Medicine, Keck Sch of Medicine of the Univ of Southern California, Rancho Mirage, CA Background We have previously demonstrated that nasopharyngeal cooling (NPC) initiated during CPR improves the success of resuscitation. In the present study, we compared the effects of NPC with cold saline infusion (CSI) on hemodynamics, amplitude spectrum area (AMSA) during CPR and ultimate resuscitation outcome in a porcine model of prolonged cardiac arrest. We hypothesized that NPC would yield better resuscitation outcome when compared to CSI when both were initiated during CPR. Methods Ventricular fibrillation (VF) was induced in 14 pigs weighing 38±2 kg. After 15 minutes of untreated VF, CPR was performed for 5 minutes prior to defibrillation. Coincident with the start of CPR, animals were randomized to receive NPC with the aid of the RhinoChill Device or CSI with 30 mL/kg 4°C saline. One hour after ROSC, surface cooling with the aid of a water blanket was begun in both groups and maintained at 35.4°C for 4 hours. Results During CPR, jugular vein temperature was significantly decreased in animals subjected to NPC in comparison to those receiving CSI (P<0.01). Core temperature, however, was decreased only in animals receiving CSI (P<0.01). Coronary Perfusion Pressure was significantly greater in the animals treated with NPC (P=0.02). AMSA values in NPC group was significantly higher than CSI group (P=0.03). All 7 animals treated with NPC were successfully resuscitated in contrast to only 2 in the CSI group (P=0.02). Conclusion In this model, NPC improved hemodynamics and AMSA during CPR and this was associated with increases in the success of resuscitation.

  • Abstract P51: Nasopharyngeal Cooling Improves Coronary Perfusion Pressure and Amplitude Spectrum Area During CPR in Comparison to Systemic Cold Saline Infusion in a Porcine Model of Prolonged Cardiac Arrest
    Circulation, 2009
    Co-Authors: Giuseppe Ristagno, Max Harry Weil, Wanchun Tang
    Abstract:

    P51: Nasopharyngeal Cooling Improves Coronary Perfusion Pressure and Amplitude Spectrum Area During CPR in Comparison to Systemic Cold Saline Infusion in a Porcine Model of Prolonged Cardiac Arrest Tao Yu; Giuseppe Ristagno; Yongqin Li; Max H Weil; Wanchun Tang 1 Weil Institute of Critical Care Medicine, the Second Affiliated Hosp of Sun Yat-sen Univ, Rancho Mirage, CA 2 Weil Institute of Critical Care Medicine, Rancho Mirage, CA 3 Weil Institute of Critical Care Medicine, the Second Affiliated Hosp of Sun Yat-sen Univ, Rancho Mirage, CA 4 Weil Institute of Critical Care Medicine, Keck Sch of Medicine of the Univ of Southern California, Rancho Mirage, CA Background We have previously demonstrated that nasopharyngeal cooling (NPC) initiated during CPR improves the success of resuscitation. In the present study, we compared the effects of NPC with cold saline infusion (CSI) on hemodynamics, amplitude spectrum area (AMSA) during CPR and ultimate resuscitation outcome in a porcine model of prolonged cardiac arrest. We hypothesized that NPC would yield better resuscitation outcome when compared to CSI when both were initiated during CPR. Methods Ventricular fibrillation (VF) was induced in 14 pigs weighing 38±2 kg. After 15 minutes of untreated VF, CPR was performed for 5 minutes prior to defibrillation. Coincident with the start of CPR, animals were randomized to receive NPC with the aid of the RhinoChill Device or CSI with 30 mL/kg 4°C saline. One hour after ROSC, surface cooling with the aid of a water blanket was begun in both groups and maintained at 35.4°C for 4 hours. Results During CPR, jugular vein temperature was significantly decreased in animals subjected to NPC in comparison to those receiving CSI (P