1
|
Hord EC, Hager MP, Bolch CM, Bonugli K, Guo LJ, Tuzun E, Criscione JC. Preclinical Proof-of-Concept of a Minimally Invasive Direct Cardiac Compression Device for Pediatric Heart Support. Cardiovasc Eng Technol 2024; 15:147-158. [PMID: 38110762 PMCID: PMC11116177 DOI: 10.1007/s13239-023-00703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE For pediatric patients, extracorporeal membrane oxygenation (ECMO) remains the predominant mechanical circulatory support (MCS) modality for heart failure (HF) although survival to discharge rates remain between 50 and 60% for these patients. The device-blood interface and disruption of physiologic hemodynamics are significant contributors to poor outcomes. METHODS In this study, we evaluate the preclinical feasibility of a minimally invasive, non-blood-contacting pediatric DCC prototype for temporary MCS. Proof-of-concept is demonstrated in vivo in an animal model of HF. Hemodynamic pressures and flows were examined. RESULTS Minimally invasive deployment on the beating heart was successful without cardiopulmonary bypass or anticoagulation. During HF, device operation resulted in an immediate 43% increase in cardiac output while maintaining pulsatile hemodynamics. Compared to the pre-HF baseline, the device recovered up to 95% of ventricular stroke volume. At the conclusion of the study, the device was easily removed from the beating heart. CONCLUSIONS This preclinical proof-of-concept study demonstrated the feasibility of a DCC device on a pediatric scale that is minimally invasive and non-blood contacting, with promising hemodynamic support and durability for the initial intended duration of use. The ability of DCC to maintain pulsatile MCS without blood contact represents an opportunity to mitigate the mortality and morbidity observed in non-pulsatile, blood-contacting MCS.
Collapse
Affiliation(s)
- Erica C Hord
- CorInnova, Inc. JLABS @ TMC, 2450 Holcombe Blvd Suite J, Houston, TX, 77021, USA
| | - Melanie P Hager
- Department of Biomedical Engineering, Texas A&M University, 5045 Emerging Technologies Building 3120 TAMU, College Station, TX, 77843-3120, USA
- Texas A&M University College of Medicine, 3050 Health Professions Education Building 1359 TAMU, Bryan, TX, 77807-1359, USA
| | - Christina M Bolch
- CorInnova, Inc. JLABS @ TMC, 2450 Holcombe Blvd Suite J, Houston, TX, 77021, USA
| | - Katherine Bonugli
- Texas A&M University Institute for Preclinical Studies, 4478 TAMU, College Station, TX, 77843-4478, USA
| | - Lee-Jae Guo
- Texas A&M University Institute for Preclinical Studies, 4478 TAMU, College Station, TX, 77843-4478, USA
| | - Egemen Tuzun
- Texas A&M University Institute for Preclinical Studies, 4478 TAMU, College Station, TX, 77843-4478, USA
| | - John C Criscione
- CorInnova, Inc. JLABS @ TMC, 2450 Holcombe Blvd Suite J, Houston, TX, 77021, USA.
- Department of Biomedical Engineering, Texas A&M University, 5045 Emerging Technologies Building 3120 TAMU, College Station, TX, 77843-3120, USA.
- Texas A&M University College of Medicine, 3050 Health Professions Education Building 1359 TAMU, Bryan, TX, 77807-1359, USA.
| |
Collapse
|
2
|
Wu Y, Luo J, Chen T, Zhan H, Liu J, Chen J, Wang S. Successful ECMO-assisted open chest cardiopulmonary resuscitation in a postpartum patient with delayed amniotic fluid embolism. Eur J Med Res 2022; 27:19. [PMID: 35115037 PMCID: PMC8815117 DOI: 10.1186/s40001-021-00628-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/30/2021] [Indexed: 11/14/2022] Open
Abstract
Background Amniotic fluid embolism (AFE) is a rare but potentially dangerous severe obstetrics complication, which is accompanied by an incidence between 1.9 and 6.1 per 100,000 births. Case presentation Here, we report an AFE case after cesarean delivery diagnosed on a cardiac arrest complicated by acute respiratory distress syndrome and coagulopathy. Diagnosis, risk factors and pathophysiology for AFE have been fully discussed, besides, extracorporeal membrane oxygenation in the early management of cardiac arrest was used, describing the indication, efficacy and successful performed of open-chest cardiopulmonary resuscitation for the patient. Conclusion In AFE with cute cardiovascular collapse, extracorporeal membrane oxygenation support can be considered as the alternative therapies. The rare but dangerous amniotic fluid embolish after cesarean delivery was diagnosed. A cardiac arrest accompanied by acute respiratory distress syndrome and coagulopathy was recorded. Diagnosis, risk factors and pathophysiology for amniotic fluid embolish in this case were detailly discussed.
Collapse
Affiliation(s)
- Yafen Wu
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Jin Luo
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Tao Chen
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Hong Zhan
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Jinfa Liu
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Junxing Chen
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Shouping Wang
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China.
| |
Collapse
|
3
|
Unseld J, Pflüger P, Landeg M, Dommasch M, Kanz KG, Bogner-Flatz V. [Prognostic implications of stone heart syndrome in cardiac arrest]. Unfallchirurg 2021; 124:252-256. [PMID: 32803299 PMCID: PMC7921032 DOI: 10.1007/s00113-020-00856-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Der Begriff Stone heart ist definiert als systolische Kontraktur des Herzens und wird auch als kontraktiler Herzstillstand bezeichnet. Er wurde erstmals 1972 durch den US-amerikanischen Herzchirurgen Denton Cooley bei Patienten mit Bypass-Operation beschrieben. Das Stone heart ist meist Folge eines prolongierten Herz-Kreislauf-Stillstands, welcher zu einer Anoxie bzw. Hypoxie des Myokards führt. Es wird über 3 Traumapatienten berichtet, welche nach kardiopulmonaler Reanimation in der postmortalen Computertomographie (CT) ein Stone-heart-Phänomen zeigten.
Collapse
Affiliation(s)
- J Unseld
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der LMU München, München, Deutschland
| | - Patrick Pflüger
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
| | - Maximilian Landeg
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der LMU München, München, Deutschland
| | - Michael Dommasch
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - K-G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - V Bogner-Flatz
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der LMU München, München, Deutschland
| |
Collapse
|
4
|
Jack MW, Wierenga JR, Bridges JP, Baltzer WI, Crosse KR. Feasibility of open-chest cardiopulmonary resuscitation through a transdiaphragmatic approach in dogs. Vet Surg 2019; 48:1042-1049. [PMID: 31120588 DOI: 10.1111/vsu.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/24/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe and evaluate the feasibility of a transdiaphragmatic (TD) approach for open-chest cardiopulmonary resuscitation (OCCPR) as an alternative to a traditional lateral thoracotomy (LT) in a canine cadaver model. STUDY DESIGN Randomized noninferiority ex vivo study. ANIMALS Fourteen canine cadavers weighing 17.4-30.2 kg. METHODS An LT and a TD approach to the heart were performed in each cadaver. The order of procedures as well as an assignment to specific operators were randomized before starting the study. Data recorded included the time between incision and initiation of cardiac compressions; time between initiation of the first suture placement and closure of the intrapleural space; time between initiation of the first suture placement and final skin suture; trauma to pulmonary, cardiac, hepatic and neurovascular structures; distance between the caval foramen and diaphragmatic incision; the intercostal space entered during LT; and appropriate closure. RESULTS The mean time between incision and initiation of cardiac compressions for the TD approach (85 ± 35 seconds) was noninferior to the LT (84 ± 28 seconds). The pleural space was closed faster after the TD approach (531 ± 276 seconds) than after the lateral approach (817 ± 294 seconds, P = .03). Total duration of closure did not differ between techniques (P = .11). There was no difference between the complication rates of each approach. CONCLUSION The TD approach did not prolong the procedure or increase the complication rate compared with an LT. CLINICAL SIGNIFICANCE This study provides evidence to support additional investigation of the TD approach for OCCPR to determine its efficacy and safety in live animals.
Collapse
Affiliation(s)
- Malcolm W Jack
- Small Animal Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - Janelle R Wierenga
- Small Animal Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - Janis P Bridges
- Small Animal Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - Wendy I Baltzer
- Small Animal Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - Katherine R Crosse
- Small Animal Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| |
Collapse
|
5
|
Krawczyk P, Andres J. Unexpected perioperative cardiac arrest. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
6
|
Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0330-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2016; 95:100-47. [PMID: 26477701 DOI: 10.1016/j.resuscitation.2015.07.016] [Citation(s) in RCA: 916] [Impact Index Per Article: 114.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Pierre Carli
- SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France
| | - Tommaso Pellis
- Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | - Markus B Skrifvars
- Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Gary B Smith
- Centre of Postgraduate Medical Research & Education, Bournemouth University, Bournemouth, UK
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
| | | |
Collapse
|
8
|
Chokengarmwong N, Ortiz LA, Raja A, Goldstein JN, Huang F, Yeh DD. Outcome of patients receiving CPR in the ED of an urban academic hospital. Am J Emerg Med 2016; 34:1595-9. [PMID: 27339223 DOI: 10.1016/j.ajem.2016.05.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The success of Closed Chest Cardiopulmonary Resuscitation (CC-CPR) degrades with prolonged times. Open Chest CPR (OC-CPR) is an alternative that may lead to superior coronary and cerebral perfusion. It is critical to determine when continued CC-CPR is unlikely to be successful to justify initiating OC-CPR as rescue therapy. The purpose of this study is to review CC-CPR outcomes to define a time threshold for attempting OC-CPR. METHODS We identified all adult non-trauma patients diagnosed with cardiac arrest, ventricular fibrillation, ventricular tachycardia and asystole from 1/1/10-12/31/14. We collected demographics, cardiac rhythm, resuscitation duration, survival to hospital discharge and neurological outcome. Using time to ROSC after ED arrival and good neurological outcome, we explored various times as triggers for attempting OC-CPR. RESULTS Among 242 cases of CPR, 205 cases were out-of-hospital cardiac arrest (OHCA). Mean age was 63.7 (±16.9),woman comprised 29.8% (72/242), and median prehospital CPR time was 30 min (20-44). Patients suffering ED arrest had improved ROSC (54.1% vs. 12.7%, p<0.001) and survival to hospital discharge rates (37.8% vs. 2.9%, p<0.001) compared to OHCA. Patients achieving ROSC had median total CPR duration of 18 minutes (10 minutes of pre-hospital CPR) compared with patients without ROSC who had 45 minutes (30 pre-hospital) respectively. No patient receiving > 10 minutes of CPR in the ED survived to hospital discharge. CONCLUSION In patients suffering OHCA and requiring CC-CPR in the ED, overall survival rate to good neurologic function is low. OC-CPR could potentially be attempted after 10 minutes of CC-CPR in the ED.
Collapse
Affiliation(s)
- Nalin Chokengarmwong
- King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Luis Alfonso Ortiz
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ali Raja
- Department of Emergency Medicinex, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Joshua N Goldstein
- Department of Emergency Medicinex, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Fei Huang
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - D Dante Yeh
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| |
Collapse
|
9
|
Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars M, Smith G, Sunde K, Deakin C. Erweiterte Reanimationsmaßnahmen für Erwachsene („adult advanced life support“). Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0085-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|