Cardiopulmonary Resuscitation–associated Lung Edema (CRALE). A Translational Study

Abstract

<b>Rationale:</b> Cardiopulmonary resuscitation is the cornerstone of cardiac arrest (CA) treatment. However, lung injuries associated with it have been reported.<b>Objectives:</b> To assess <i>1</i>) the presence and characteristics of lung abnormalities induced by cardiopulmonary resuscitation and <i>2</i>) the role of mechanical and manual chest compression (CC) in its development.<b>Methods:</b> This translational study included <i>1</i>) a porcine model of CA and cardiopulmonary resuscitation (<i>n</i> = 12) and <i>2</i>) a multicenter cohort of patients with out-of-hospital CA undergoing mechanical or manual CC (<i>n</i> = 52). Lung computed tomography performed after resuscitation was assessed qualitatively and quantitatively along with respiratory mechanics and gas exchanges.<b>Measurements and Main Results:</b> The lung weight in the mechanical CC group was higher compared with the manual CC group in the experimental (431 ± 127 vs. 273 ± 66, <i>P</i> = 0.022) and clinical study (1,208 ± 630 vs. 837 ± 306, <i>P</i> = 0.006). The mechanical CC group showed significantly lower oxygenation (<i>P</i> = 0.043) and respiratory system compliance (<i>P</i> < 0.001) compared with the manual CC group in the experimental study. The variation of right atrial pressure was significantly higher in the mechanical compared with the manual CC group (54 ± 11 vs. 31 ± 6 mm Hg, <i>P</i> = 0.001) and significantly correlated with lung weight (<i>r</i> = 0.686, <i>P</i> = 0.026) and respiratory system compliance (<i>r</i> = -0.634, <i>P</i> = 0.027). Incidence of abnormal lung density was higher in patients treated with mechanical compared with manual CC (37% vs. 8%, <i>P</i> = 0.018).<b>Conclusions:</b> This study demonstrated the presence of cardiopulmonary resuscitation-associated lung edema in animals and in patients with out-of-hospital CA, which is more pronounced after mechanical as opposed to manual CC and correlates with higher swings of right atrial pressure during CC.