Resuscitation After Prolonged Cardiac Arrest: Role of Cardiopulmonary Bypass and Systemic Hyperkalemia Oliver J. Liakopoulos, MD, Bradley S. Allen, MD,

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Resuscitation After Prolonged Cardiac Arrest: Role of Cardiopulmonary Bypass and Systemic Hyperkalemia Oliver J. Liakopoulos, MD, Bradley S. Allen, MD, Gerald D. Buckberg, MD, Nikola Hristov, MD, Zhongtuo Tan, MD, J. Pablo Villablanca, MD, Georg Trummer, MD The Annals of Thoracic Surgery Volume 89, Issue 6, Pages 1972-1979 (June 2010) DOI: 10.1016/j.athoracsur.2010.02.052 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Resuscitation outcome of animals (n = 31) subjected to 15 minutes of cardiac arrest (CA) followed by 10 minutes of cardiopulmonary resuscitation–advanced life support (CPR-ALS). Note: CPR-ALS restored cardiac heart rhythm in 35% of animals, whereas in 65% cardiopulmonary bypass (CPB) was established for refractory ventricular fibrillation (VF). (Hypo = hypotension.) The Annals of Thoracic Surgery 2010 89, 1972-1979DOI: (10.1016/j.athoracsur.2010.02.052) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Mean potassium plasma concentrations (mEq/L) in animals with or without receiving a potassium bolus after 10 minutes on cardiopulmonary bypass (CPB). Note the elevated potassium levels after sudden cardiac death and cardiopulmonary resuscitation–advanced life support. Furthermore, animals receiving potassium had higher potassium concentrations at 15 to 60 minutes on cardiopulmonary bypass when compared with untreated animals. Data are mean ± standard error of the mean. *p < 0.05 compared with baseline values (base); #p < 0.05 compared with untreated animals. The Annals of Thoracic Surgery 2010 89, 1972-1979DOI: (10.1016/j.athoracsur.2010.02.052) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Axial T2-weighted slices at the level of the basal ganglia from the same subject. Note the hyperintensity in the caudate, globus pallidus, and putamen in the T2 sequence (A) that appears with an increased diffusion signal in the diffusion-weighted image sequence (B), suggesting symmetric hypoxic injury (white arrows). These zones are also accompanied by a hypointensity in the axial sequences (C), indicating true tissue ischemia with completed infarction of the basal ganglia. The Annals of Thoracic Surgery 2010 89, 1972-1979DOI: (10.1016/j.athoracsur.2010.02.052) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions