scholarly journals Effects of rewarming with extracorporeal membrane oxygenation to restore oxygen transport and organ blood flow after hypothermic cardiac arrest in a porcine model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jan Harald Nilsen ◽  
Torstein Schanche ◽  
Sergei Valkov ◽  
Rizwan Mohyuddin ◽  
Brage Haaheim ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Spontaneous Circulation ◽  
Aerobic Metabolism ◽  
Organ Blood Flow ◽  
Membrane Oxygenation ◽  
Chain Of Survival ◽  
Low Levels ◽  
The Brain

AbstractWe recently documented that cardiopulmonary resuscitation (CPR) generates the same level of cardiac output (CO) and mean arterial pressure (MAP) during both normothermia (38 °C) and hypothermia (27 °C). Furthermore, continuous CPR at 27 °C provides O2 delivery (ḊO2) to support aerobic metabolism throughout a 3-h period. The aim of the present study was to investigate the effects of extracorporeal membrane oxygenation (ECMO) rewarming to restore ḊO2 and organ blood flow after prolonged hypothermic cardiac arrest. Eight male pigs were anesthetized and immersion cooled to 27 °C. After induction of hypothermic cardiac arrest, CPR was started and continued for a 3-h period. Thereafter, the animals were rewarmed with ECMO. Organ blood flow was measured using microspheres. After cooling with spontaneous circulation to 27 °C, MAP and CO were initially reduced to 66 and 44% of baseline, respectively. By 15 min after the onset of CPR, there was a further reduction in MAP and CO to 42 and 25% of baseline, respectively, which remained unchanged throughout the rest of 3-h CPR. During CPR, ḊO2 and O2 uptake (V̇O2) fell to critical low levels, but the simultaneous small increase in lactate and a modest reduction in pH, indicated the presence of maintained aerobic metabolism. Rewarming with ECMO restored MAP, CO, ḊO2, and blood flow to the heart and to parts of the brain, whereas flow to kidneys, stomach, liver and spleen remained significantly reduced. CPR for 3-h at 27 °C with sustained lower levels of CO and MAP maintained aerobic metabolism sufficient to support ḊO2. Rewarming with ECMO restores blood flow to the heart and brain, and creates a “shockable” cardiac rhythm. Thus, like continuous CPR, ECMO rewarming plays a crucial role in “the chain of survival” when resuscitating victims of hypothermic cardiac arrest.

scholarly journals Effects of Rewarming with Extracorporeal Membrane Oxygenation to Restore Oxygen Transport and Organ Blood Flow After Hypothermic Cardiac Arrest in a Porcine Model.

2021 ◽  
Author(s):  
Jan Harald Nilsen ◽  
Torstein Schanche ◽  
Sergei Valkov ◽  
Rizwan Mohyuddin ◽  
Brage Haaheim ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Spontaneous Circulation ◽  
Aerobic Metabolism ◽  
Organ Blood Flow ◽  
Membrane Oxygenation ◽  
Chain Of Survival ◽  
Low Levels ◽  
The Brain

Abstract Background: We recently documented that cardiopulmonary resuscitation (CPR) for hypothermic cardiac arrest maintains cardiac output (CO) and mean arterial pressure (MAP) to the same reduced level during normothermia (38°C) vs. hypothermia (27°C). Furthermore, continuous CPR at 27°C maintains CO and MAP throughout a 3-h period, and provides O2 delivery to support aerobic metabolism. The aim of the present study was to investigate the effects of extracorporeal membrane oxygenation (ECMO) rewarming to restore O2 delivery and organ blood flow. Methods: Eight male pigs were anesthetized and immersion cooled to 27°C. After induction of hypothermic cardiac arrest, CPR was started and continued for a 3-h period. Thereafter, the animals were rewarmed with ECMO. Organ blood flow was measured using microspheres. Results: After cooling with spontaneous circulation to 27°C, MAP and CO were initially reduced to 66 and 44% of baseline, respectively. By 15 min after the onset of CPR, there was a further reduction in MAP and CO to 42 and 25% of baseline, respectively, which remained unchanged throughout the rest of 3-h CPR. During CPR, O2 delivery and O2 uptake (V̇O2) fell to critical low levels, but the simultaneous small increase in lactate and a modest reduction in pH, indicated the presence of maintained aerobic metabolism. Rewarming with ECMO restored MAP, CO, O2 delivery, and blood flow to the heart and to parts of the brain, whereas flow to kidneys, stomach, liver and spleen remained significantly reduced. Conclusions: CPR for 3-h at 27°C with sustained lower levels of CO and MAP and maintained aerobic metabolism sufficient to support O2 delivery. Rewarming with ECMO restores blood flow to the heart and brain, and creates a “shockable” cardiac rhythm. Thus, like continuous CPR, ECMO rewarming plays a crucial role in “the chain of survival” when resuscitating victims of hypothermic cardiac arrest.

scholarly journals Rewarming With Closed Thoracic Lavage Following 3-h CPR at 27°C Failed to Reestablish a Perfusing Rhythm

2021 ◽  
Vol 12 ◽  
Author(s):  
Joar O. Nivfors ◽  
Rizwan Mohyuddin ◽  
Torstein Schanche ◽  
Jan Harald Nilsen ◽  
Sergei Valkov ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Cardiac Output ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Aerobic Metabolism ◽  
Organ Blood Flow ◽  
Circulatory Collapse ◽  
Low Levels ◽  
Modest Reduction

Introduction: Previously, we showed that the cardiopulmonary resuscitation (CPR) for hypothermic cardiac arrest (HCA) maintained cardiac output (CO) and mean arterial pressure (MAP) to the same reduced level during normothermia (38°C) vs. hypothermia (27°C). In addition, at 27°C, the CPR for 3-h provided global O2 delivery (DO2) to support aerobic metabolism. The present study investigated if rewarming with closed thoracic lavage induces a perfusing rhythm after 3-h continuous CPR at 27°C.Materials and Methods: Eight male pigs were anesthetized, and immersion-cooled. At 27°C, HCA was electrically induced, CPR was started and continued for a 3-h period. Thereafter, the animals were rewarmed by combining closed thoracic lavage and continued CPR. Organ blood flow was measured using microspheres.Results: After cooling with spontaneous circulation to 27°C, MAP and CO were initially reduced by 37 and 58% from baseline, respectively. By 15 min after the onset of CPR, MAP, and CO were further reduced by 58 and 77% from baseline, respectively, which remained unchanged throughout the rest of the 3-h period of CPR. During CPR at 27°C, DO2 and O2 extraction rate (VO2) fell to critically low levels, but the simultaneous small increase in lactate and a modest reduction in pH, indicated the presence of maintained aerobic metabolism. During rewarming with closed thoracic lavage, all animals displayed ventricular fibrillation, but only one animal could be electro-converted to restore a short-lived perfusing rhythm. Rewarming ended in circulatory collapse in all the animals at 38°C.Conclusion: The CPR for 3-h at 27°C managed to sustain lower levels of CO and MAP sufficient to support global DO2. Rewarming accidental hypothermia patients following prolonged CPR for HCA with closed thoracic lavage is not an alternative to rewarming by extra-corporeal life support as these patients are often in need of massive cardio-pulmonary support during as well as after rewarming.

scholarly journals The use of veno-venous extracorporeal membrane oxygenation following thrombolysis for massive pulmonary embolism

2017 ◽  
Vol 18 (4) ◽  
pp. 342-347 ◽  
Author(s):  
Alister Seaton ◽  
Luke E Hodgson ◽  
Ben Creagh-Brown ◽  
Adrian Pakavakis ◽  
Duncan LA Wyncoll ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Short Term ◽  
Excellent Outcome ◽  
Cardiorespiratory Failure ◽  
Membrane Oxygenation ◽  
Retrieval Team

A 59-year-old man was diagnosed with a massive pulmonary embolism. Despite thrombolysis there were two episodes of cardiac arrest and following recovery of spontaneous circulation profound cardiorespiratory failure ensued. An extracorporeal membrane oxygenation retrieval team initiated veno-venous extracorporeal membrane oxygenation on site to facilitate transfer to the extracorporeal membrane oxygenation centre. An excellent outcome is reported in the short term. This represents one of the few published cases of veno-venous extracorporeal membrane oxygenation for a massive pulmonary embolism following thrombolysis.

BLOOD FLOW IN THE REPRODUCTIVE ORGANS OF THE MOUSE AFTER HYPOPHYSECTOMY, AFTER GONADOTROPHIN TREATMENT, DURING THE OESTROUS CYCLE AND DURING EARLY PREGNANCY

1969 ◽  
Vol 44 (4) ◽  
pp. 523-536 ◽  
Author(s):  
B. M. BINDON
Keyword(s):  
Blood Flow ◽  
Early Pregnancy ◽  
Reproductive Organs ◽  
Oestrous Cycle ◽  
Unit Weight ◽  
Organ Blood Flow ◽  
Uterine Blood Flow ◽  
Low Levels ◽  
The Brain ◽  
In Pregnancy

SUMMARY The indicator fractionation technique was examined and found to be of value in the measurement of organ blood flow in the anaesthetized female mouse with [131I]iodoantipyrine as the indicator substance. Blood flow per unit weight of the brain and ovary was shown to decline rapidly after hypophysectomy. A single injection of pregnant mare serum gonadotrophin (PMS), given 4 days after hypophysectomy, restored the blood flow of these organs to normal levels. Uterine blood flow was unaffected by hypophysectomy, and was significantly increased by PMS injection. Significant changes in brain, ovarian and uterine blood flow were observed during the oestrous cycle, early pregnancy and in mice induced to ovulate by injections of gonadotrophin. There was a tendency for brain and ovarian blood flow to decline before ovulation. By contrast, significant transient increases in blood flow to the brain and ovary were observed on day 3 of pregnancy. It is thought that these changes are related to the mechanisms which initiate implantation. Uterine blood flow was lowest in mated and unmated mice on the day of oestrus and rose to peak levels 2 days later. In pregnancy, however, peak uterine blood flow was recorded between days 3 and 4 and was higher than at any stage in the oestrous cycle. Although it tended to fall after day 3, uterine blood flow in pregnancy did not decline again to low levels as it did in the oestrous cycle. The possible physiological significance of the results is discussed, and the limitations to their interpretation are considered.

scholarly journals Massive pulmonary embolism with intra-hospital cardiac arrest and full recovery of right ventricular function after veno-arterial extracorporeal membrane oxygenation therapy: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-6
Author(s):  
Stephan Camen ◽  
Gerold Söffker ◽  
Stefan Kluge ◽  
Elvin Zengin
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
Emergency Situation ◽  
Complete Recovery ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Membrane Oxygenation

Abstract Background Massive pulmonary embolism (PE) with shock constitutes a life-threatening disease, challenging physicians with the need for fast decision-making in an emergency situation. While thrombolytic treatment or thrombectomy are considered the treatment of choice in high-risk PE, these strategies might not be able to unload the right ventricle (RV) fast enough in some patients with severe cardiogenic shock. Case summary We present a case of a patient with massive bilateral central PE who presented in cardiogenic shock, rapidly deteriorating to cardiac arrest. After successful re-establishing spontaneous circulation, the patient remained highly unstable, necessitating a treatment strategy ensuring a quick stabilization of the circulation. Therefore, we decided to use veno-arterial extracorporeal membrane oxygenation (vaECMO) as a supportive strategy allowing for autolysis of the lung to dissolve the thrombi (bridge to recovery). We were able to wean the patient from vaECMO support within 4 days and documented a complete recovery of right ventricular in echocardiography before hospital discharge. Discussion The concept of vaECMO treatment alone might be a valuable alternative in selected patients with massive PE and cardiogenic shock, in whom thrombolytic therapy might not unload the RV fast enough.

Abstract 13649: Asymmetric Cerebral Perfusion in Comatose Extracorporeal Membrane Oxygenation Patients

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Imad Khan ◽  
Thomas Johnson ◽  
Irfaan Dar ◽  
Kelly Donohue ◽  
Yan Xu ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Cerebral Blood Flow ◽  
Extracorporeal Membrane Oxygenation ◽  
Cerebral Perfusion ◽  
Standard Of Care ◽  
Correlation Spectroscopy ◽  
Absolute Difference ◽  
Membrane Oxygenation ◽  
Cardiac Circulation

Asymmetric cerebral perfusion can occur when extracorporeal membrane oxygenation (ECMO) flow competes with native cardiac circulation. It is unclear whether this phenomenon associates with brain injury. Diffuse correlation spectroscopy (DCS) provides continuous, laser-based, non-invasive, bedside monitoring of relative cerebral blood flow (rCBF). This study measured rCBF in ECMO patients via DCS to determine whether comatose patients experience asymmetric cerebral perfusion. Adults receiving ECMO for any indication were prospectively recruited from 12/2019-3/2021. Patients with prior neurologic injury, scalp/facial lacerations, and SARS-CoV-2 infection were excluded. DCS monitoring was performed daily during ECMO support with sensors placed on bilateral foreheads. Mean arterial pressure (MAP) was continuously recorded from the bedside monitor. The Glasgow Coma Scale (GCS) was assessed by clinical staff multiple times daily with sedation pauses, if possible, per standard of care. rCBF was calculated by comparing continuous cerebral blood flow (CBF) measurements to the daily median CBF, then averaged at each MAP value. Daily rCBF asymmetry was calculated by summing the absolute difference of rCBF between the two hemispheres at each MAP value, normalized for the total MAP range experienced by the patient that day. Twelve subjects were enrolled in this study (ages 21-78, 6 with cardiac arrest, 4 with acute heart failure, 2 with ARDS) and grouped by maximum GCS motor (GCS-M) score during ECMO, with 3 “comatose” subjects (GCS-M ≤ 4), and 9 “awake” subjects (GCS-M > 4). DCS was performed over 66 sessions with a mean duration of 131.83 ± 1.13 minutes. Comatose subjects exhibited more rCBF asymmetry than awake subjects (0.28 ± 0.06 mmHg-1 vs. 0.10 ± 0.001 mmHg-1, p=0.045). No difference in asymmetry was noted between patients with or without cardiac arrest. We found that comatose ECMO subjects exhibited higher inter-hemispheric rCBF asymmetry over a range of blood pressures than awake subjects. Though our comatose sample is small, further validation of this finding and its causes, such as cerebrovascular dysregulation, is warranted.

scholarly journals Functional Activation of Cerebral Blood Flow after Cardiac Arrest in Rat

1997 ◽  
Vol 17 (11) ◽  
pp. 1202-1209 ◽  
Author(s):  
Bernd Schmitz ◽  
Bernd W. Böttiger ◽  
Konstantin-A. Hossmann
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Evoked Potentials ◽  
Laser Doppler Flowmetry ◽  
Somatosensory Evoked Potentials ◽  
Spontaneous Circulation ◽  
Laser Doppler ◽  
Doppler Flowmetry ◽  
Return Of Spontaneous Circulation ◽  
The Brain

After a period of global cerebral ischemia, CO2 reactivity and the hemodynamic–metabolic activation to functional stimulation are transiently suppressed. This raises the question of whether the impaired functional coupling reflects disturbances of functional integrity of the brain or an impaired cerebrovascular reactivity. We, therefore, compared the recovery of CO2 reactivity with that of somatosensory evoked potentials, functional flow activation and neurologic deficits in a rodent model of cardiac arrest-induced cerebral ischemia, followed by up to 7 days of reperfusion. Cardiac arrest of 10 minutes' duration was produced in 24 animals by electrical fibrillation of the heart. Five animals were sham-operated controls. Resuscitation was performed by external cardiac massage, using standard resuscitation procedures. Functional activation was carried out under chloralose anesthesia by electrical stimulation of forepaws. CO2 reactivity was tested by ventilation of animals with 6% CO2. During functional and hypercapnic stimulation CBF was measured in the somatosensory cortex using laser–Doppler flowmetry, and at the end of the experiment by 14C-iodoantipyrine autoradiography. Neurologic deficits were scored by evaluating consciousness and various sensory and motor functions. In control animals 6% CO2 increased CBF measured by laser–Doppler flowmetry by 28.8% ± 8.7%. Forepaw stimulation generated somatosensory evoked potentials with an amplitude of 750 ± 217 μV and increased CBF measured by laser–Doppler flowmetry by 86.0% ± 18.1%. After return of spontaneous circulation, CO2 reactivity was transiently reduced to about 30% of control at 1 hour of reperfusion ( P < 0.05) but returned to near control at 5 hours. Somatosensory evoked potential amplitudes were reduced to 15% of control at 45 minutes of reperfusion and returned to only 50% to 60% at 3 and 7 days after return of spontaneous circulation ( P < 0.05). Functional activation of blood flow was completely suppressed during the first hour after return of spontaneous circulation but also recovered to 50% to 60% of control at 3 days after return of spontaneous circulation ( P < 0.05). Linear regression analysis revealed a significant correlation between recovery of functional activation of blood flow and both recovery of the amplitude of somatosensory evoked potentials ( P = 0.03) and the neurologic deficit score ( P = 0.02), but not between neurologic deficit score and recovery of CO2 reactivity or somatosensory evoked potential amplitudes. These data demonstrate that the suppression of functional activation of blood flow after 10 minutes cardiac arrest is not related to impairment of coupling mechanisms but reflects ongoing disturbances of the functional integrity of the brain. Assessment of functional flow coupling is a reliable way to study postischemic recovery of the brain.

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