scholarly journals O10 Myocardial tolerance to exsanguination and retrieval using whole blood-selective aortic arch perfusion

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
M J Madurska ◽  
N N Elansary ◽  
N Pate ◽  
J Edwards ◽  
M J Richmond ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Aortic Arch ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Spontaneous Circulation ◽  
Treatment Modalities ◽  
Swine Model ◽  
Male Adult ◽  
Resuscitation Fluid ◽  
Baseline Characteristics

Abstract Introduction Exsanguination cardiac arrest is the leading preventable cause of death in trauma. Treatment modalities are limited, and prognosis remains dismal. Selective aortic arch perfusion (SAAP) is an emerging endovascular resuscitation technique consisting of aortic occlusion and perfusion of coronary and cerebral circulation with oxygenated resuscitation fluid. Translational research has demonstrated promising outcomes; however, little is known about the duration of cardiac arrest beyond which the myocardium cannot be resuscitated. The aims of this study are to assess the myocardial tolerance to exsanguination cardiac arrest before successful return of spontaneous circulation (ROSC) following resuscitation with SAAP, and 1-hour survival. Method 23 male adult swine were anaesthetised and instrumented. Controlled hemorrhage was performed until cardiac arrest defined by MAP <20 mmHg. Animals were randomized into 3 groups: 5, 10 and 15 minutes of cardiac arrest before resuscitation with SAAP. Following ROSC animals were observed for 60 minutes. Result Baseline characteristics were similar between groups (P > 0.05). ROSC was 100% (8/8) in the 5 min group, 75% (6/8) and 43% (3/7) in 10- and 15-min groups respectively (P = 0.042). 60 min survival was 75%, 50% and 14% in 5-, 10- and 15-min groups respectively (P = 0.015). 1-hour survivors in the 5 min group required less noradrenaline 23.6 (±7.4) compared to other animals 40.9 (±25.8), (P = 0.008). Conclusion Selective aortic arch perfusion is an effective resuscitative tool in eliciting ROSC in a swine model of exsanguination cardiac arrest lasting >5 min. Sustainable resuscitability using SAAP declines after 10 min of exsanguination cardiac arrest. Take-home Message SAAP is an emerging resuscitation technique with promising outcomes in exsanguination cardiac arrest and may be a segway to Extracorporeal life support. The time limit for resuscitability of the myocardium lies somewhere between 10 and 15 min after the start of exsanguination cardiac arrest.

scholarly journals Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis

2021 ◽  
Vol 10 (16) ◽  
pp. 3583
Author(s):  
Styliani Syntila ◽  
Georgios Chatzis ◽  
Birgit Markus ◽  
Holger Ahrens ◽  
Christian Waechter ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Survival Rates ◽  
Limb Ischemia ◽  
Spontaneous Circulation ◽  
Access Site ◽  
Baseline Characteristics ◽  
Hospital Cardiac Arrest

Our aim was to compare the outcomes of Impella with extracorporeal life support (ECLS) in patients with post-cardiac arrest cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective study of patients resuscitated from out of hospital cardiac arrest (OHCA) with post-cardiac arrest CS following AMI (May 2015 to May 2020). Patients were supported either with Impella 2.5/CP or ECLS. Outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between groups. 159 patients were included (Impella, n = 105; ECLS, n = 54). Hospital and 12-month survival rates were comparable in the Impella and the ECLS groups (p = 0.16 and p = 0.3, respectively). After adjustment for baseline differences, both groups demonstrated comparable hospital and 12-month survival (p = 0.36 and p = 0.64, respectively). Impella patients had a significantly greater left ventricle ejection-fraction (LVEF) improvement at 96 h (p < 0.01 vs. p = 0.44 in ECLS) and significantly fewer device-associated complications than ECLS patients (15.2% versus 35.2%, p < 0.01 for relevant access site bleeding, 7.6% versus 20.4%, p = 0.04 for limb ischemia needing intervention). In subgroup analyses, Impella was associated with better survival in patients with lower-risk features (lactate < 8.6 mmol/L, time from collapse to return of spontaneous circulation < 28 min, vasoactive score < 46 and Horowitz index > 182). In conclusion, the use of Impella 2.5/CP or ECLS in post-cardiac arrest CS after AMI was associated with comparable adjusted hospital and 12-month survival. Impella patients had a greater LVEF improvement than ECLS patients. Device-related access-site complications occurred more frequently in patients with ECLS than Impella support.

Abstract 19091: Prognosis of Patients With Out-of-hospital Refractory Cardiac Arrest Referred for Extracorporeal Life Support: An Observational Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Cecile Ursat ◽  
Marie-Ange Tilliette ◽  
Charles Groizard ◽  
Margot Cassuto ◽  
Anna Ozguler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Spontaneous Circulation ◽  
Flow Time ◽  
Low Flow ◽  
Time Interval ◽  
Specific Situation ◽  
Time Intervals ◽  
Paris Area

Introduction: In case of no return of spontaneous circulation (ROSC) after conventional cardio-pulmonary resuscitation (CPR), out-of-hospital cardiac arrest (OHCA) patients could be referred for extracorporeal life support (ECLS). Guidelines have been published concerning this specific situation (1). The aim of our study was to describe the prognosis of OHCA patients and verify if referral to ECLS was compliant with these recommendations mainly studying time intervals (no-flow < 5 min, low-flow < 100 min). Methods: A prospective survey on OHCA referred to ECLS was implemented from 03/01/12 until 06/11/15 in an Emergency Medical Service (EMS) located in Paris area (France). This survey included 43 patients referred to hospital for ECLS. Variables were given as means and percentages. Results: Patients referred to ECLS were more often men (77%), with a mean age of 51 years old. Most of 43 OHCA occurred at home (51%), although 26% occurred on public area and 16% at workplace. In 40% of cases, CPR was performed by a witness and in 33% by a health professional. A first Basic Life Support ambulance arrived on scene within 7 min 50 sec, whereas EMS ambulance arrived on scene within 18 min 27 sec after OHCA. At EMS arrival on scene, patients were on asystole (44%), ventricular fibrillation (37%), and on spontaneous circulation (12%). The no-flow time interval was 4 min 10 sec on average (6 patients had a no-flow over 5 min) with 43% of patients with no no-flow. Low-flow time-interval was 44 min. External electric shock was delivered before EMS arrival on 21% of cases, and EMS itself delivered a shock in 40% of cases. Epinephrine was used for all patients, 10.35 mg on average. No patient survived OHCA after referral to ECLS. Discussion: Although this is a small series of 43 patients, no OHCA patient referred to ECLS survived. These results are mainly due to a non-shockable initial condition or too long no-flow time intervals. In order to improve the outcome and bring benefit to the proper expected patients through a cost-effective pathway, we released a reminder of the right recommendations in our EMS. (1) Riou B., Adnet F., Baud F et al. A. Recommandation sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires. Ann Fr Anesth Réanim 2009 ; 28 : 182-6.

scholarly journals Resuscitative endovascular balloon occlusion of the aorta vs epinephrine in the treatment of non-traumatic cardiac arrest in swine

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alice Hutin ◽  
Yaël Levy ◽  
Fanny Lidouren ◽  
Matthias Kohlhauer ◽  
Pierre Carli ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Life Support ◽  
Statistical Significance ◽  
Spontaneous Circulation ◽  
Balloon Occlusion ◽  
Swine Model ◽  
Epinephrine Administration ◽  
Traumatic Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Abstract Background The administration of epinephrine in the management of non-traumatic cardiac arrest remains recommended despite controversial effects on neurologic outcome. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) could be an interesting alternative. The aim of this study was to compare the effects of these 2 strategies on return of spontaneous circulation (ROSC) and cerebral hemodynamics during cardiopulmonary resuscitation (CPR) in a swine model of non-traumatic cardiac arrest. Results Anesthetized pigs were instrumented and submitted to ventricular fibrillation. After 4 min of no-flow and 18 min of basic life support (BLS) using a mechanical CPR device, animals were randomly submitted to either REBOA or epinephrine administration before defibrillation attempts. Six animals were included in each experimental group (Epinephrine or REBOA). Hemodynamic parameters were similar in both groups during BLS, i.e., before randomization. After epinephrine administration or REBOA, mean arterial pressure, coronary and cerebral perfusion pressures similarly increased in both groups. However, carotid blood flow (CBF) and cerebral regional oxygenation saturation were significantly higher with REBOA as compared to epinephrine administration (+ 125% and + 40%, respectively). ROSC was obtained in 5 animals in both groups. After resuscitation, CBF remained lower in the epinephrine group as compared to REBOA, but it did not achieve statistical significance. Conclusions During CPR, REBOA is as efficient as epinephrine to facilitate ROSC. Unlike epinephrine, REBOA transitorily increases cerebral blood flow and could avoid its cerebral detrimental effects during CPR. These experimental findings suggest that the use of REBOA could be beneficial in the treatment of non-traumatic cardiac arrest.

The comparison of humeral intraosseous and intravenous administration of vasopressin on return of spontaneous circulation and pharmacokinetics in a hypovolemic cardiac arrest swine model

2016 ◽  
Vol 11 (4) ◽  
pp. 237-242 ◽  
Author(s):  
Mark H. Wimmer, BSN ◽  
Kenneth Heffner, BSN ◽  
Michael Smithers, BSN ◽  
Richard Culley, BSN ◽  
Jennifer Coyner, PhD, CRNA ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Analysis Of Variance ◽  
Repeated Measures ◽  
Maximum Concentration ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Control Group ◽  
Swine Model ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference

Introduction: The American Heart Association (AHA) recommends intravenous (IV) or intraosseous (IO) vasopressin in Advanced Cardiac Life Support (ACLS). Obtaining IV access in hypovolemic cardiac arrest patients can be difficult, and IO access is often obtained in these life threatening situations. No studies have been conducted to determine the effects of humeral IO (HIO) access with vasopressin in the return of spontaneous circulation (ROSC). Our study compared the kinetics of vasopressin and ROSC with HIO with IV access in the hypovolemic swine model.Methods: Twenty-two Yorkshire swine were divided into three groups: HIO (n = 7), IV (n = 8), and a control group (n = 7). The IV and HIO group received vasopressin and cardiopulmonary resuscitation (CPR), while the control group received only CPR. All subjects were exsanguinated 31 percent of their blood volume, placed in cardiac arrest, and resuscitated per ACLS. Subjects that achieved ROSC were then monitored for 20 minutes. Blood samples (10 mL) collected at 0.5, 1, 1.5, 2, 2.5, 3, and 4 minutes after vasopressin injection and analyzed for maximum concentration (Cmax) and time to maximum concentration (Tmax). Data were analyzed using a multivariate analysis of variance (MANOVA) and a Fisher's Exact Test.Results: ROSC was achieved in every subject that received vasopressin via the HIO route. Data analysis using a MANOVA pairwise comparison revealed no difference between mean Cmax (p = 0.601) and Tmax (p = 0.771) of vasopressin administered IV versus HIO routes. Analysis of the mean serum concentrations at time intervals using a repeated measures analysis of variance found no difference (p 0.05). A Fisher's Exact Test revealed no difference in rate of ROSC between HIO and IV groups (p 0.05). Odds ratio determined that there was a 33 times higher chance of survival among HIO subjects versus control (CPR and Defibrillation; p = 0.03) and no difference in the survivability of the HIO or IV groups (p = 0.52). Conclusion: The data from this study strongly suggest that there is no significant difference in ROSC, time to ROSC, hemodynamics, or pharmacokinetics between HIO vasopressin and IV vasopressin. This research reinforces current AHA guidelines recommending the use of HIO route early over delaying care awaiting IV access.

scholarly journals Cardiopulmonary resuscitation in a swine model of cardiac arrest

2017 ◽  
Vol 58 (3) ◽  
pp. 232
Author(s):  
T. XANTHOS (Θ. ΞΑΝΘΟΣ) ◽  
E. BASSIAKOU (Ε. ΜΠΑΣΙΑΚΟΥ) ◽  
D. PAPADIMITRIOU (Δ. ΠΑΠΑΔΗΜΗΤΡΙΟΥ) ◽  
E. KOUDOUNA (Ε. ΚΟΥΔΟΥΝΑ) ◽  
P. LELOVAS (Π. ΛΕΛΟΒΑΣ) ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Lithium Battery ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Medical Emergency ◽  
Swine Model ◽  
Coronary Perfusion ◽  
Jugular Veins ◽  
Successful Resuscitation

Introduction: Cardiac arrest (CA) is a daunting medical emergency. In order to answer various questions regarding CA, and furthermore to implement novel therapeutic strategies, various animal models have been used.Aim: The aim of the present study is to describe the experimental model of CA and cardiopulmonary resuscitation (CPR), developed in our department.Materials and methods: Twenty pigs were anaesthetized and intubated. The internal jugular veins were surgically prepared, together with the carotid artery. Ventricular fibrillation (VF) was induced with an ordinary lithium battery through a pacing wire inserted into the right ventricle. The animals were resuscitated with the 2005 advanced life support algorythm (ALS), as proposed by International organizations. If the animals restored spontaneous circulation, they were further monitored for 30 minutes.Results: Nine animals restored spontaneous circulation with the implementation of the aforementioned protocol. Successful resuscitation was associated with the coronary perfusion pressure and PETCQ2 during external cardiac compressions.Conclusions: The use of an ordinary lithium battery is a safe and efficient way to induce CA. Swine baseline hemodynamics closely resemble those of human, making the swine model, a favorable model for experimental CA-induction and CPR.

scholarly journals Non-invasive diffuse optical neuromonitoring during cardiopulmonary resuscitation predicts return of spontaneous circulation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tiffany S. Ko ◽  
Constantine D. Mavroudis ◽  
Ryan W. Morgan ◽  
Wesley B. Baker ◽  
Alexandra M. Marquez ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hemoglobin Concentration ◽  
Spontaneous Circulation ◽  
Youden Index ◽  
Swine Model ◽  
Return Of Spontaneous Circulation ◽  
Non Invasive ◽  
Tissue Optical Properties ◽  
Tenfold Cross Validation

AbstractNeurologic injury is a leading cause of morbidity and mortality following pediatric cardiac arrest. In this study, we assess the feasibility of quantitative, non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) neuromonitoring during cardiopulmonary resuscitation (CPR), and its predictive utility for return of spontaneous circulation (ROSC) in an established pediatric swine model of cardiac arrest. Cerebral tissue optical properties, oxy- and deoxy-hemoglobin concentration ([HbO2], [Hb]), oxygen saturation (StO2) and total hemoglobin concentration (THC) were measured by a FD-DOS probe placed on the forehead in 1-month-old swine (8–11 kg; n = 52) during seven minutes of asphyxiation followed by twenty minutes of CPR. ROSC prediction and time-dependent performance of prediction throughout early CPR (< 10 min), were assessed by the weighted Youden index (Jw, w = 0.1) with tenfold cross-validation. FD-DOS CPR data was successfully acquired in 48/52 animals; 37/48 achieved ROSC. Changes in scattering coefficient (785 nm), [HbO2], StO2 and THC from baseline were significantly different in ROSC versus No-ROSC subjects (p < 0.01) after 10 min of CPR. Change in [HbO2] of + 1.3 µmol/L from 1-min of CPR achieved the highest weighted Youden index (0.96) for ROSC prediction. We demonstrate feasibility of quantitative, non-invasive FD-DOS neuromonitoring, and stable, specific, early ROSC prediction from the third minute of CPR.

Survival and Factors Associated with Survival with Extracorporeal Life Support During Cardiac Arrest

ASAIO Journal ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Vassili Panagides ◽  
Marc Laine ◽  
Guillaume Fond ◽  
Guillaume Lebreton ◽  
Franck Paganelli ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Factors Associated

Abstract 273: Noninvasive Mitochondrial Modulation: Neuroprotection in a Translational Model of Cardiac Arrest and Resuscitation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Joseph M Wider ◽  
Erin Gruley ◽  
Jennifer Mathieu ◽  
Emma Murphy ◽  
Rachel Mount ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Near Infrared ◽  
Small Animal ◽  
Spontaneous Circulation ◽  
Infrared Light ◽  
Swine Model ◽  
Treatment Groups ◽  
The Brain ◽  
Neuroprotective Therapies

Background: Mitochondrial dysfunction contributes to cardiac arrest induced brain injury and has been a target for neuroprotective therapies. An emerging concept suggests that hyperactivation of neuronal mitochondria following resuscitation results in hyperpolarization of the mitochondrial membrane during reperfusion, which drives generation of excess reactive oxygen species. Previous studies from our group demonstrated that limiting mitochondrial hyperactivity by non-invasively modulating mitochondrial function with specific near infrared light (NIR) wavelengths can reduce brain injury in small animal models of global and focal ischemia. Hypothesis: Inhibitory wavelengths of NIR will reduce neuronal injury and improve neurocognitive outcome in a clinically relevant swine model of cardiac arrest. Methods: Twenty-eight male and female adult swine were enrolled (3 groups: Sham, CA/CPR, and CA/CPR + NIR). Cardiac arrest (8 minutes) was induced with a ventricular pacing wire and followed by manual CPR with defibrillation and epinephrine every 30 seconds until return of spontaneous circulation (ROSC), 2 of the 20 swine that underwent CA did not achieve ROSC and were not enrolled. Treatment groups were randomized prior to arrest and blinded to the CPR team. Treatment was applied at onset of ROSC by irradiating the scalp with 750 nm and 950 nm LEDs (5W) for 2 hours. Results: Sham-operated animals all survived (8/8), whereas 22% of untreated animals subjected to cardiac arrest died within 45 min of ROSC (CA/CPR, n= 7/9). All swine treated with NIR survived the duration of the study (CA/CPR + NIR, n=9/9). Four days following cardiac arrest, neurological deficit score was improved in the NIR treatment group (50 ± 21 CA/CPR vs. 0.8 ± 0.8 CA/CPR + NIR, p < 0.05). Additionally, neuronal death in the CA1/CA3 regions of the hippocampus, assessed by counting surviving neurons with stereology, was attenuated by treatment with NIR (17917 ± 5534 neurons/mm 3 CA/CPR vs. 44655 ± 5637 neurons/mm 3 CA/CPR + NIR, p < 0.05). All data is reported as mean ± SEM. Conclusions: These data provide evidence that noninvasive modulation of mitochondria, achieved by transcranial irradiation of the brain with NIR, mitigates post-cardiac arrest brain injury.

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