Cardiopulmonary Resuscitation-Associated Lung Edema (CRALE) - A Translational Study

Rationale: Cardiopulmonary Resuscitation is the cornerstone of cardiac arrest (CA) treatment. However, lung injuries associated with it have been reported. Objectives: To assess 1) the presence and characteristics of lung abnormalities induced by Cardiopulmonary Resuscitation and 2) the role of mechanical and manual chest compression (CC) in its development. Methods: This translational study included : 1) a porcine model of CA and Cardiopulmonary Resuscitation (n=12), 2) a multicenter cohort of out-of-hospital CA patients undergoing mechanical or manual CC (n=52). Lung Computed Tomography performed after resuscitation was assessed qualitatively and quantitatively along with with respiratory mechanics and gas exchanges. Measurements and main results: The lung weight in the mechanical CC group was higher compared to the manual CC group in the experimental (431±127 vs 273±66, p=0.022) and clinical study (1208±630vs837±306, p=0.006). The mechanical CC group showed significantly lower oxygenation (p=0.043) and respiratory system compliance (Cpl,rs) (p<0.001) compared to the manual CC group in the experimental study. The variation of right atrial pressure was significantly higher in the mechanical compared to the manual CC group (54±11vs31±6 mmHg, p=0.001) and significantly correlated with lung weight (r=0.686, p=0.026) and Cpl,rs (r=-0.634, p=0.027). Incidence of abnormal lung density was higher in patients treated with mechanical compared to manual CC (37% vs 8%, p=0.018). Conclusions: This study demonstrated the presence of Cardiopulmonary Resuscitation Associated Lung Edema (CRALE) in animals and in out-of-hospital CA patients, which is more pronounced after mechanical- as opposed to manual CC and correlates with higher swings of right atrial pressure during CC.