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Billig S, Zayat R, Yelenski S, Nix C, Bennek-Schoepping E, Hochhausen N, Derwall M. The Self-Expandable Impella CP (ECP) as a Mechanical Resuscitation Device. Bioengineering (Basel) 2024; 11:456. [PMID: 38790323 PMCID: PMC11118512 DOI: 10.3390/bioengineering11050456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
The survival rate of cardiac arrest (CA) can be improved by utilizing percutaneous left ventricular assist devices (pLVADs) instead of conventional chest compressions. However, existing pLVADs require complex fluoroscopy-guided placement along a guidewire and suffer from limited blood flow due to their cross-sectional area. The recently developed self-expandable Impella CP (ECP) pLVAD addresses these limitations by enabling guidewire-free placement and increasing the pump cross-sectional area. This study evaluates the feasibility of resuscitation using the Impella ECP in a swine CA model. Eleven anesthetized pigs (73.8 ± 1.7 kg) underwent electrically induced CA, were left untreated for 5 min and then received pLVAD insertion and activation. Vasopressors were administered and defibrillations were attempted. Five hours after the return of spontaneous circulation (ROSC), the pLVAD was removed, and animals were monitored for an additional hour. Hemodynamics were assessed and myocardial function was evaluated using echocardiography. Successful guidewire-free pLVAD placement was achieved in all animals. Resuscitation was successful in 75% of cases, with 3.5 ± 2.0 defibrillations and 1.8 ± 0.4 mg norepinephrine used per ROSC. Hemodynamics remained stable post-device removal, with no adverse effects or aortic valve damage observed. The Impella ECP facilitated rapid guidewire-free pLVAD placement in fibrillating hearts, enabling successful resuscitation. These findings support a broader clinical adoption of pLVADs, particularly the Impella ECP, for CA.
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Affiliation(s)
- Sebastian Billig
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Rachad Zayat
- Department of Cardiothoracic Surgery, Heart Center Trier, Barmherzigen Brüder Hospital Trier, 54292 Trier, Germany
| | - Siarhei Yelenski
- Department of Thoracic Surgery, Medical Faculty RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | | | | | - Nadine Hochhausen
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Matthias Derwall
- Department of Anesthesia, Critical Care and Pain Medicine, St. Johannes Hospital, 44137 Dortmund, Germany
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Gottula AL, McCracken BM, Nakashima T, Greer NL, Cramer TA, Sutton NR, Ward KR, Neumar RW, Hakam Tiba M, Hsu CH. Percutaneous left ventricular assist devices in refractory cardiac arrest: The role of chest compressions. Resusc Plus 2023; 16:100488. [PMID: 38143529 PMCID: PMC10746849 DOI: 10.1016/j.resplu.2023.100488] [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: 06/27/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 12/26/2023] Open
Abstract
Background Recent studies describe an emerging role for percutaneous left ventricular assist devices such as Impella CP® as rescue therapy for refractory cardiac arrest. We hypothesized that the addition of mechanical chest compressions to percutaneous left ventricular assist device assisted CPR would improve hemodynamics by compressing the right ventricle and augmenting pulmonary blood flow and left ventricular filling. We performed a pilot study to test this hypothesis using a swine model of prolonged cardiac arrest. Methods Eight Yorkshire swine were anesthetized, intubated, and instrumented for hemodynamic monitoring. They were subjected to untreated ventricular fibrillation for 5.75 (SD 2.90) minutes followed by mechanical chest compressions for a mean of 20.0 (SD 5.0) minutes before initiation of percutaneous left ventricular assist device. After percutaneous left ventricular assist device initiation, mechanical chest compressions was stopped (n = 4) or continued (n = 4). Defibrillation was attempted 4, 8 and 12 minutes after initiating percutaneous left ventricular assist device circulatory support. Results The percutaneous left ventricular assist device + mechanical chest compressions group had significantly higher percutaneous left ventricular assist device flow prior to return of spontaneous heartbeat at four- and twelve-minutes after percutaneous left ventricular assist device initiation, and significantly higher end tidal CO2 at 4-minutes after percutaneous left ventricular assist device initiation, when compared with the percutaneous left ventricular assist device alone group. Carotid artery flow was not significantly different between the two groups. Conclusion The addition of mechanical chest compressions to percutaneous left ventricular assist device support during cardiac arrest may generate higher percutaneous left ventricular assist device and carotid artery flow prior to return of spontaneous heartbeat compared to percutaneous left ventricular assist device alone. Further studies are needed to determine if this approach improves other hemodynamic parameters or outcomes after prolonged cardiac arrest.
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Affiliation(s)
- Adam L. Gottula
- Department of Emergency Medicine and Anesthesiology, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Brendan M. McCracken
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Takahiro Nakashima
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Nicholas L. Greer
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Traci A. Cramer
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Nadia R. Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
| | - Kevin R. Ward
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Robert W. Neumar
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Mohamad Hakam Tiba
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Cindy H. Hsu
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
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Nakashima T, Hakam Tiba M, McCracken BM, Hsu CH, Gottula AL, Greer NL, Cramer TA, Sutton NR, Ward KR, Neumar RW. Effect of percutaneous ventricular assisted device on post-cardiac arrest myocardial dysfunction in swine model with prolonged cardiac arrest. Resuscitation 2023; 193:110010. [PMID: 37884220 DOI: 10.1016/j.resuscitation.2023.110010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND It remains unclear if percutaneous left ventricular assist device (pLVAD) reduces post-cardiac arrest myocardial dysfunction. METHODS This is a prespecified analysis of a subset of swine that achieved return of spontaneous circulation (ROSC) in a study comparing pLVAD, transient aortic occlusion (AO), or both during cardiopulmonary resuscitation (CPR). Devices were initiated after 24 minutes of ventricular fibrillation cardiac arrest (8 min no-flow and 16 min mechanical CPR). AO was discontinued post-ROSC, and pLVAD support or standard care were continued. Beginning 60 minutes post-ROSC, pLVAD support was weaned to < 1.0 L/min and subsequently removed at 240 minutes. The primary outcome was cardiac index (CI), stroke volume index (SVI), and left ventricular ejection fraction (LVEF) at 240 minutes post-ROSC. Data are shown as mean (standard error). RESULTS Seventeen swine achieved ROSC without complication and were included in this analysis (pLVAD group, n = 11 and standard care group, n = 6). For the primary outcomes, the pLVAD group had significantly higher CI of 4.2(0.3) vs. 3.1(0.4) L/min/m2 (p = 0.043) and LVEF 60(3) vs. 49(4) % (p = 0.029) at 240 minutes after ROSC when compared with the standard care group, while SVI was not statistically significantly different (32[3] vs. 23[4] mL/min/m2, p = 0.054). During the first 60 minutes post-ROSC, the pLVAD group had significantly higher coronary perfusion pressure, lower LV stroke work index, and total pulmonary resistance index. CONCLUSION These results suggest that early pLVAD support after ROSC is associated with better recovery myocardial function compared to standard care after prolonged cardiac arrest.
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Affiliation(s)
- Takahiro Nakashima
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Mohamad Hakam Tiba
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Brendan M McCracken
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Cindy H Hsu
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Adam L Gottula
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas L Greer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Traci A Cramer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, MI, United States; Department of Biomedical Engineering, Vanderbilt University, Nashville, MI, United States
| | - Kevin R Ward
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States
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Tiba MH, Nakashima T, McCracken BM, Hsu CH, Gottula AL, Greer NL, Cramer TA, Sutton NR, Ward KR, Neumar RW. Haemodynamic impact of aortic balloon occlusion combined with percutaneous left ventricular assist device during cardiopulmonary resuscitation in a swine model of cardiac arrest. Resuscitation 2023; 189:109885. [PMID: 37385400 DOI: 10.1016/j.resuscitation.2023.109885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
AIM To investigate the effect of tandem use of transient balloon occlusion of the descending aorta (AO) and percutaneous left ventricular assist device (pl-VAD) during cardiopulmonary resuscitation in a large animal model of prolonged cardiac arrest. METHODS Ventricular fibrillation was induced and left untreated for 8 minutes followed by 16 minutes of mechanical CPR (mCPR) in 24 swine, under general anesthesia. Animals were randomized to 3 treatment groups (n = 8 per group): A) pL-VAD (Impella CP®) B) pL-VAD+AO, and C) AO. Impella CP® and the aortic balloon catheter were inserted via the femoral arteries. mCPR was continued during treatment. Defibrillation was attempted 3 times starting at minute 28 and then every 4 minutes. Haemodynamic, cardiac function and blood gas measurements were recorded for up to 4 hours. RESULTS Coronary perfusion pressure (CoPP) in the pL-VAD+AO Group increased by a mean (SD) of 29.2(13.94) mmHg compared to an increase of 7.1(12.08) and 7.1(5.95) mmHg for groups pL-VAD and AO respectively (p = 0.02). Similarly, cerebral perfusion pressure (CePP) in pL-VAD+AO increased by a mean (SD) of 23.6 (6.11), mmHg compared with 0.97 (9.07) and 6.9 (7.98) mmHg for the other two groups (p < 0.001). The rate of return of spontaneous heartbeat (ROSHB) was 87.5%, 75%, and 100% for pL-VAD+AO, pL-VAD, and AO. CONCLUSION Combined AO and pL-VAD improved CPR hemodynamics compared to either intervention alone in this swine model of prolonged cardiac arrest.
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Affiliation(s)
- Mohamad Hakam Tiba
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Takahiro Nakashima
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Brendan M McCracken
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States.
| | - Cindy H Hsu
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Adam L Gottula
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Nicholas L Greer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Traci A Cramer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
| | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Kevin R Ward
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States.
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Qin H, Wang L, Yu B, Xing D, Su J, Bai Z. Effect of other venous access on cardiopulmonary resuscitation quality: A prospective, randomized, controlled trial. Biotechnol Genet Eng Rev 2023:1-11. [PMID: 37066803 DOI: 10.1080/02648725.2023.2199239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
This randomized controlled study aimed to prospectively evaluate the application effects of other venous access in patients undergoing cardiopulmonary resuscitation. A total of 212 patients who underwent respiratory and cardiac arrest were randomly divided into peripheral intravenous (IV) access group (IV group, n = 69), femoral vein catheterization group (FVC group, n = 72), and internal jugular vein catheterization group (IJVC group, n = 71). The puncture time, first administration time, pressure interruption time caused by the establishment of fluid pathway, endotracheal intubation time, complications, ROSC time, and ETCO2 were recorded. The time of establishing venous access was: IV<FVC<IJVC. The once puncture success rate of the FVC group was markedly higher than that in IV and IJVC groups (P < 0.01). There was no significant difference in ROSC time between the FVC, IV, and the IJVC group (P = 0.23). The ROSC time in the FVC group was higher than in the IV and IJVC groups (P < 0.01). The success rate of ROSC in the FVC group and IJVC group were better than that in the IV group (PVC>IJVC>IV, P = 0.04). There was no significant difference in EtCO2 between the FVC, IV group, and IJVC group (PVC>IJVC>IV, P = 0.17). Due to catheterization, the time of suspending chest compression in the FVC group was significantly lower than in the IJVC group (5s vs. 12s). The time of establishing an artificial airway in the IV (38s) and FVC (35s) group were significantly longer than that in IJVC (52s) group. Central venous catheterization is more effective than peripheral venous catheterization in cardiopulmonary resuscitation. Moreover, femoral vein access was more effective than internal jugular vein access.
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Affiliation(s)
- Hao Qin
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lantao Wang
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bin Yu
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dong Xing
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jie Su
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zongjiang Bai
- Emergency Department, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Harhash AA, Kern KB. Cardiac arrest in the catheterization laboratory: Are we getting better at resuscitation? Resuscitation 2022; 180:8-10. [PMID: 36058319 DOI: 10.1016/j.resuscitation.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Ahmed A Harhash
- University of Vermont Medical Center, Burlington, VT, United States
| | - Karl B Kern
- University of Arizona Sarver Heart Center, Tucson, AZ, United States.
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Dunning J, Archbold A, de Bono JP, Butterfield L, Curzen N, Deakin CD, Gudde E, Keeble TR, Keys A, Lewis M, O'Keeffe N, Sarma J, Stout M, Swindell P, Ray S. Joint British Societies' guideline on management of cardiac arrest in the cardiac catheter laboratory. BRITISH HEART JOURNAL 2022; 108:e3. [PMID: 35470236 DOI: 10.1136/heartjnl-2021-320588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.
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Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
| | - Andrew Archbold
- Department of General & Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Joseph Paul de Bono
- Department of Cardiology, Queen Elizabeth Hospital, University of Birmingham, Birmingham, West Midlands, UK
| | - Liz Butterfield
- School of Nursing, Midwifery and Social Work, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton and Department of Cardiology, Southampton, UK
| | - Charles D Deakin
- Anaesthesia and Intensive Care, Southampton University Hospitals NHS Trust, Southampton, Southampton, UK
| | - Ellie Gudde
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Alan Keys
- Cardiovascular Care Partnership (UK), British Cardiovascular Society, London, London, UK
| | - Mike Lewis
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, UK
| | - Niall O'Keeffe
- Department of Cardiothoracic Anaesthesia and Critical Care, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Jaydeep Sarma
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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Manzo-Silberman S, Nix C, Goetzenich A, Demondion P, Kang C, Bonneau M, Cohen-Solal A, Leprince P, Lebreton G. Severe Myocardial Dysfunction after Non-Ischemic Cardiac Arrest: Effectiveness of Percutaneous Assist Devices. J Clin Med 2021; 10:jcm10163623. [PMID: 34441919 PMCID: PMC8396996 DOI: 10.3390/jcm10163623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction: Despite the improvements in standardized cardiopulmonary resuscitation, survival remains low, mainly due to initial myocardial dysfunction and hemodynamic instability. Our goal was to compare the efficacy of two left ventricular assist devices on resuscitation and hemodynamic supply in a porcine model of ventricular fibrillation (VF) cardiac arrest. Methods: Seventeen anaesthetized pigs had 12 min of untreated VF followed by 6 min of chest compression and boluses of epinephrine. Next, a first defibrillation was attempted and pigs were randomized to any of the three groups: control (n = 5), implantation of an percutaneous left ventricular assist device (Impella, n = 5) or extracorporeal membrane oxygenation (ECMO, n = 7). Hemodynamic and myocardial functions were evaluated invasively at baseline, at return of spontaneous circulation (ROSC), after 10–30–60–120–240 min post-resuscitation. The primary endpoint was the rate of ROSC. Results: Only one of 5 pigs in the control group, 5 of 5 pigs in the Impella group, and 5 of 7 pigs in the ECMO group had ROSC (p < 0.05). Left ventricular ejection fraction at 240 min post-resuscitation was 37.5 ± 6.2% in the ECMO group vs. 23 ± 3% in the Impella group (p = 0.06). No significant difference in hemodynamic parameters was observed between the two ventricular assist devices. Conclusion: Early mechanical circulatory support appeared to improve resuscitation rates in a shockable rhythm model of cardiac arrest. This approach appears promising and should be further evaluated.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Denis Diderot University, INSERM UMRS 942, 75010 Paris, France;
- Correspondence: ; Tel.: +33-661135334 or +33-149958224
| | - Christoph Nix
- Abiomed Europe GmbH, Neuenhofer Weg 3, D-52074 Aachen, Germany; (C.N.); (A.G.)
| | - Andreas Goetzenich
- Abiomed Europe GmbH, Neuenhofer Weg 3, D-52074 Aachen, Germany; (C.N.); (A.G.)
| | - Pierre Demondion
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (P.D.); (P.L.); (G.L.)
| | - Chantal Kang
- XP-MED, 78100 Saint Germain en Laye, France; (C.K.); (M.B.)
| | - Michel Bonneau
- XP-MED, 78100 Saint Germain en Laye, France; (C.K.); (M.B.)
| | - Alain Cohen-Solal
- Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Denis Diderot University, INSERM UMRS 942, 75010 Paris, France;
| | - Pascal Leprince
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (P.D.); (P.L.); (G.L.)
| | - Guillaume Lebreton
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France; (P.D.); (P.L.); (G.L.)
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9
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Mørk SR, Stengaard C, Linde L, Møller JE, Jensen LO, Schmidt H, Riber LP, Andreasen JB, Thomassen SA, Laugesen H, Freeman PM, Christensen S, Greisen JR, Tang M, Møller-Sørensen PH, Holmvang L, Gregers E, Kjaergaard J, Hassager C, Eiskjær H, Terkelsen CJ. Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:174. [PMID: 34022934 PMCID: PMC8141159 DOI: 10.1186/s13054-021-03606-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 12/16/2022]
Abstract
Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03606-5.
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Affiliation(s)
- Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Carsten Stengaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Henrik Schmidt
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Lars Peter Riber
- Department of Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jo Bønding Andreasen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Sisse Anette Thomassen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Laugesen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Raben Greisen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mariann Tang
- Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
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