The effect of resuscitation position on cerebral and coronary perfusion pressure during mechanical cardiopulmonary resuscitation in porcine cardiac arrest model

Abstract Background A ‘catecholamine storm’ in a case of pheochromocytoma can lead to a transient left ventricular dysfunction similar to Takotsubo cardiomyopathy. A cardiogenic shock can thus develop, with high left ventricular end-diastolic pressure and a reduction in coronary perfusion pressure. This scenario can ultimately lead to a cardiac arrest, in which unloading the left ventricle with a peripheral left ventricular assist device (Impella®) could help in achieving the return of spontaneous circulation (ROSC). Case summary A patient affected by Takotsubo cardiomyopathy caused by a pheochromocytoma presented with cardiogenic shock that finally evolved into refractory cardiac arrest. Cardiopulmonary resuscitation was performed but ROSC was achieved only after Impella® placement. Discussion In the clinical scenario of Takotsubo cardiomyopathy due to pheochromocytoma, when cardiogenic shock develops treatment is difficult because exogenous catecholamines, required to maintain organ perfusion, could exacerbate hypertension and deteriorate the cardiomyopathy. Moreover, as the coronary perfusion pressure is critically reduced, refractory cardiac arrest could develop. Although veno-arterial extra-corporeal membrane oxygenation (va-ECMO) has been advocated as the treatment of choice for in-hospital refractory cardiac arrest, in the presence of left ventricular overload a device like Impella®, which carries fewer complications as compared to ECMO, could be effective in obtaining the ROSC by unloading the left ventricle.

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Blood Pressure– and Coronary Perfusion Pressure–Targeted Cardiopulmonary Resuscitation Improves 24-Hour Survival From Ventricular Fibrillation Cardiac Arrest

Critical Care Medicine ◽

10.1097/ccm.0000000000001859 ◽

2016 ◽

Vol 44 (11) ◽

pp. e1111-e1117 ◽

Cited By ~ 34

Author(s):

Maryam Y. Naim ◽

Robert M. Sutton ◽

Stuart H. Friess ◽

George Bratinov ◽

Utpal Bhalala ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Cardiopulmonary Resuscitation ◽

Perfusion Pressure ◽

Coronary Perfusion Pressure ◽

Coronary Perfusion

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Coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial extracorporeal membrane oxygenation and intraaortic balloon counterpulsation

Critical Care ◽

10.1186/cc10880 ◽

2012 ◽

Vol 16 (S1) ◽

Cited By ~ 3

Author(s):

J Bělohlávek ◽

M Mlcek ◽

M Huptych ◽

S Havranek ◽

P Ostadal ◽

...

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Perfusion Pressure ◽

Coronary Perfusion Pressure ◽

Pig Model ◽

Coronary Perfusion ◽

Intraaortic Balloon ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Intraaortic Balloon Counterpulsation ◽

Balloon Counterpulsation

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Coronary Perfusion Pressure During Cardiopulmonary Resuscitation After Spinal Anesthesia in Dogs

Anesthesia & Analgesia ◽

10.1213/00000539-199601000-00014 ◽

1996 ◽

Vol 82 (1) ◽

pp. 84-87

Author(s):

Jack M. Rosenberg ◽

Joyce A. Wahr ◽

Ho Choon Sung ◽

Young Suk Oh ◽

Lori J. Gilligan

Keyword(s):

Cardiopulmonary Resuscitation ◽

Spinal Anesthesia ◽

Perfusion Pressure ◽

Coronary Perfusion Pressure ◽

Coronary Perfusion

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Cardiac Arrest and Resuscitation

10.2310/im.4155 ◽

2015 ◽

Author(s):

Charles N. Pozner ◽

Jennifer L Martindale

Keyword(s):

Cardiac Arrest ◽

Ventricular Arrhythmias ◽

Perfusion Pressure ◽

Pulseless Electrical Activity ◽

Coronary Perfusion Pressure ◽

Spontaneous Circulation ◽

Coronary Perfusion ◽

Chest Compressions ◽

Cardiac Resuscitation ◽

Neurologic Function

The most effective treatment for cardiac arrest is the administration of high-quality chest compressions and early defibrillation; once spontaneous circulation is restored, post–cardiac arrest care is essential to support full return of neurologic function. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of cardiac arrest and resuscitation. Figures show the foundations of cardiac resuscitation, ventricular arrhythmias, coronary perfusion pressure as a function of time, an algorithm for initial treatment of cardiac arrest, sample capnographs, and the electrocardiographic appearance of varying degrees of hyperkalemia. Tables include components of suboptimal cardiac resuscitation and corrective actions, recommended doses of medications commonly used in cardiac resuscitation, causes of pulseless electrical activity/asystolic arrest to consider, immediate post–return of spontaneous circulation checklist, and resuscitation goals during post–cardiac arrest care. This review contains 6 highly rendered figures, 5 tables, and 142 references.

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