Abstract 363: Examination of the Effects of Extracorporeal Cardiopulmonary Resuscitation on Sublingual Microcirculation in a Swine Model of Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Brendan M McCracken ◽  
Mohamad H Tiba ◽  
Brandon C Cummings ◽  
Carmen I Colmenero ◽  
Alvaro Rojas-Pena ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Real Time ◽  
Tissue Perfusion ◽  
Dark Field ◽  
Swine Model ◽  
Sidestream Dark Field ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Significant Difference ◽  
Highly Correlated ◽  
Time Assessment

Background: Extracorporeal CPR (ECPR) is used to provide circulatory stability for organ perfusion and oxygen delivery (DO 2 ) after refractory cardiac arrest (CA). Hemodynamic measurements during ECPR may not necessarily indicate adequate perfusion at the microcirculatory level where DO 2 , oxygen consumption (VO 2 ), and oxygen exchange (O 2 ER) are most critical. In this study, we used sidestream dark-field imaging to measure total vessel density (TVD) to evaluate sublingual microcirculatory flow in a swine model of refractory CA and ECPR. Hypothesis: We hypothesize that TVD can provide real-time assessment of tissue perfusion during post-cardiac arrest ECPR that correlates with traditional measures of tissue oxygenation. Methods: Swine (8) were anesthetized and instrumented for hemodynamic monitoring. Ventricular fibrillation (VF) was induced and CPR initiated after 8min. CPR was administered using a combination of manual and mechanical chest compressions. During CPR the femoral vessels were instrumented for delivery of veno-arterial ECPR. ECPR was initiated 45min after arrest to simulate refractory CA. Sublingual TVD was measured at baseline and after 15min, 1, 2, and 3 hours of ECPR. Results: A one-way ANOVA showed significant difference between baseline TVD: 12.2(2.3)mm -1 and at 3 hours into ECPR: 6.4(3.0)mm -1 (p=0.005). TVD was highly correlated with circuit flow but not with Mean Arterial Pressure (MAP) (r=0.903, p=0.036; r=0.063, p=0.920). In addition, TVD was highly correlated with DO 2 , and lactate, (r= 0.897, p=0.039; r=-0.883, p=0.047) and moderately with VO 2 , O 2 ER, and ScvO 2 (r= 0.776, -0.370, 0.558) respectively. Conclusion: TVD appears to provide a reliable real-time assessment of tissue perfusion during post-cardiac arrest ECPR. The relationships between TVD and MAP, and TVD and flow also suggest that optimization of flow may be more important than optimizing pressure to achieve adequate tissue perfusion during ECPR.

Microvascular perfusion in cardiac arrest: a review of microcirculatory imaging studies

Perfusion ◽  
2017 ◽  
Vol 33 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Petra Krupičková ◽  
Zuzana Mormanová ◽  
Tomáš Bouček ◽  
Tomáš Belza ◽  
Jana Šmalcová ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapy Monitoring ◽  
Developed Countries ◽  
Dark Field ◽  
Therapeutic Interventions ◽  
Orthogonal Polarization ◽  
Sidestream Dark Field ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Orthogonal Polarization Spectral ◽  
The Impact

Cardiac arrest represents a leading cause of mortality and morbidity in developed countries. Extracorporeal cardiopulmonary resuscitation (ECPR) increases the chances for a beneficial outcome in victims of refractory cardiac arrest. However, ECPR and post-cardiac arrest care are affected by high mortality rates due to multi-organ failure syndrome, which is closely related to microcirculatory disorders. Therefore, microcirculation represents a key target for therapeutic interventions in post-cardiac arrest patients. However, the evaluation of tissue microcirculatory perfusion is still demanding to perform. Novel videomicroscopic technologies (Orthogonal polarization spectral, Sidestream dark field and Incident dark field imaging) might offer a promising way to perform bedside microcirculatory assessment and therapy monitoring. This review aims to summarise the recent body of knowledge on videomicroscopic imaging in a cardiac arrest setting and to discuss the impact of extracorporeal reperfusion and other therapeutic modalities on microcirculation.

scholarly journals Delayed hyperenhancement obtained by non-contrast computed tomography following coronary angiography in patients of extracorporeal cardiopulmonary resuscitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Watanabe ◽  
T Akasaka ◽  
N Sasaki ◽  
K Yamamoto
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Death ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Significant Difference ◽  
Contrast Ct ◽  
Death Group ◽  
Refractory Cardiac Arrest

Abstract Background/Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to improve survival and neurologic outcome as compared to conventional CPR in refractory cardiac arrest. Although prognostic factors of these patients have been reported, predicting of outcome is difficult in real world. Recently, early evaluation of myocardial viability in acute myocardial infarction by non-contrast computed tomography (CT) post coronary angiography (CAG) has been reported. And myocardial contrast delayed enhancement obtained by this method related to higher risk of cardiac events. However, few studies have reported delayed enhancement on left ventricular wall findings in non-contrast CT after CAG in terms of patients performed ECPR. Purpose To investigate the impact of delayed hyperenhancement obtained by non-contrast CT following CAG in patients performed ECPR. Methods We investigated 79 patients treated by ECPR for refractory cardiac arrest regardless of whether in-hospital or out-hospital in our institute from Apr 2009 to Feb 2018. Thirty-two in these patients received non-contrast CT following CAG with ECPR were enrolled. All ECPR cases underwent VA-ECMO in the catheter laboratory using percutaneous procedure while maintaining conventional CPR. Non-ECG-gated and non-contrast CT was performed using a 64-row multidetector CT scanner. Results Survival rate was 18.8% in this cohort. There was no significant difference between survive and in-hospital death group in terms of patient characteristics, clinical time courses, initial blood samples and procedure characteristics. Only delayed hyperenhancement showed significant difference between 2 groups (p=0.04). All delayed hyperenhancements were detected in only in-hospital death group. Delayed hyperenhancement was detected in 12 cases (37.5%). Initial shockable rhythm was less common in cases with delayed hyperenhancement. Cardiac death tended to be more frequent in patients with delayed hyperenhancement. The major causes of death were bleeding (41.7%) and heart failure (33%). Conclusion(s) Delayed hyperenhancement in patients treated ECPR was strong predictor of in-hospital death. Image of delayed hyperenhancement Funding Acknowledgement Type of funding source: None

scholarly journals Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Out-of-Hospital Cardiac Arrest due to Pulseless Ventricular Tachycardia/Fibrillation

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Konstantinos Dean Boudoulas ◽  
Bryan A. Whitson ◽  
David P. Keseg ◽  
Scott Lilly ◽  
Cindy Baker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Tachycardia ◽  
Cardiopulmonary Resuscitation ◽  
Medical Center ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurologic Recovery ◽  
Cardiac Catheterization Laboratory ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Background. Survival rates for out-of-hospital cardiac arrest are very low and neurologic recovery is poor. Innovative strategies have been developed to improve outcomes. A collaborative extracorporeal cardiopulmonary resuscitation (ECPR) program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire. Methods. From August 15, 2017, to June 1, 2019, there were 86 patients that were evaluated in the field for cardiac arrest in which 42 (49%) had refractory pulseless VT and/or VF resulting from different underlying pathologies and were placed on an automated cardiopulmonary resuscitation device; from these 42 patients, 16 (38%) met final inclusion criteria for ECPR and were placed on extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL). Results. From the 16 patients who underwent ECPR, 4 (25%) survived to hospital discharge with cerebral perfusion category 1 or 2. Survivors tended to be younger (48.0 ± 16.7 vs. 59.3 ± 12.7 years); however, this difference was not statistically significant (p=0.28) likely due to a small number of patients. Overall, 38% of patients underwent percutaneous coronary intervention (PCI). No significant difference was found between survivors and nonsurvivors in emergency medical services dispatch to CCL arrival time, lactate in CCL, coronary artery disease severity, undergoing PCI, and pre-ECMO PaO2, pH, and hemoglobin. Recovery was seen in different underlying pathologies. Conclusion. ECPR for out-of-hospital refractory VT/VF cardiac arrest demonstrated encouraging outcomes. Younger patients may have a greater chance of survival, perhaps the need to be more aggressive in this subgroup of patients.

scholarly journals Assessment of Deep Partial Thickness Burn Treatment with Keratin Biomaterial Hydrogels in a Swine Model

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
D. Poranki ◽  
C. Goodwin ◽  
M. Van Dyke
Keyword(s):  
Early Time ◽  
Tissue Perfusion ◽  
Swine Model ◽  
Burn Wound ◽  
Burn Treatment ◽  
Time Points ◽  
Collagen Hydrogel ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Significant Difference

Partial thickness burns can advance to full thickness after initial injury due to inadequate tissue perfusion and increased production of inflammatory cytokines, which has been referred to as burn wound progression. In previous work, we demonstrated that a keratin biomaterial hydrogel appeared to reduce burn wound progression. In the present study, we tested the hypothesis that a modified keratin hydrogel could reduce burn wound progression and speed healing. Standardized burn wounds were created in Yorkshire swine and treated within 30 minutes with keratin hydrogel (modified and unmodified), collagen hydrogel, or silver sulfadiazine (SSD). Digital images of each wound were taken for area measurements immediately prior to cleaning and dressing changes. Wound tissue was collected and assessed histologically at several time points. Wound area showed a significant difference between hydrogels and SSD groups, and rates of reepithelialization at early time points showed an increase when keratin treatment was used compared to both collagen and SSD. A linear regression model predicted a time to wound closure of approximately 25 days for keratin hydrogel while SSD treatment required 35 days. There appeared to be no measurable differences between the modified and unmodified formulations of keratin hydrogels.

Abstract 14195: Impact of Leukocyte Filtration and Leukocyte Modulation on Recovery of Heart Function After Prolonged Cardiac Arrest Treated With ECPR in a Porcine Model

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jensyn VanZalen ◽  
Takahiro Nakashima ◽  
Annie Phillips ◽  
Joseph Hill ◽  
Alyssa Enciso ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Function ◽  
Heart Function ◽  
Randomized Study ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Swine Model ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Ventricular Ejection Fraction

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) improves survival of patients with prolonged cardiac arrest (CA) that is refractory to standard CPR and ACLS. It has been proposed that ECPR accentuates inflammation after CA, potentially limiting its effectiveness. The benefits of leukocyte filters or leukocyte-modulating devices in conjunction with ECPR have not been studied. Hypothesis: When paired with ECPR, inflammation-modulating devices targeting leukocytes may improve recovery of cardiac function after prolonged cardiac arrest. Methods: In a randomized study, 24 swine (40±5kg) underwent 8min of untreated ventricular fibrillation CA followed by CPR with mechanical chest compressions and impedance threshold device for 30 min (total arrest time = 38min), immediately followed by 8h of ECPR with heparin anticoagulation and temperature maintained at 33°C. Group 1 (n=8) had standard ECPR system (control), Group 2 (n=8) had a leukocyte filter device (LF) added to the ECPR circuit, an and Group 3 (n=8) had a leukocyte modulation device (LMOD) added to the ECPR circuit. Recovery of cardiac function was measured using a cardiac resuscitablity score (CRS) and left ventricular ejection fraction (LVEF) via transthoracic echocardiography. Data was collected at baseline (prior CA) and after 8h of ECPR. Data analysis: single-factor ANOVA test (p<0.05 significance). Results: There were no statically significant differences between the groups in CRS (Control = 3.3 ± 2.4, LF = 4.0 ± 2.8, LMOD = 2.1 ± 2.6; p=0.37) or LVEF (Control = 59% ± 27%, LF = 49% ± 29% LMOD = 34% ± 38%: p=0.34) at 8 hours after ECPR initiation (Table 1). Discussion: In this swine model of prolonged cardiac arrest treated with ECPR, addition of a leukocyte filter or leukocyte modulation device to the ECPR circuit did not improve recovery of cardiac function during the first 8 hours after initiating ECPR.

scholarly journals Noninvasive Flap Monitoring using Sidestream Dark Field Microscan: A Method for Real-Time Observation of Submilimmetric Vessels

Anaplastology ◽  
2017 ◽  
Vol 06 (01) ◽  
Author(s):  
Ricardo A Yanez ◽  
Jose R Rodriguez ◽  
Ignacio J Cifuentes ◽  
Bruno L Dagnino ◽  
Sebastian A Sepulveda ◽  
...  
Keyword(s):  
Real Time ◽  
Dark Field ◽  
Sidestream Dark Field ◽  
Flap Monitoring ◽  
Time Observation ◽  
Real Time Observation

Effects of tibial and humerus intraosseous administration of epinephrine in a cardiac arrest swine model

2016 ◽  
Vol 11 (4) ◽  
pp. 243-251 ◽  
Author(s):  
Denise Beaumont, MSN, CRNA ◽  
Asal Baragchizadeh, MS, PhD Candidate ◽  
Charles Johnson, MA ◽  
Don Johnson, PhD
Keyword(s):  
Cardiac Arrest ◽  
Maximum Concentration ◽  
High Performance ◽  
Spontaneous Circulation ◽  
Swine Model ◽  
Epinephrine Administration ◽  
Life Saving ◽  
Significant Difference ◽  
Liquid Chromatography Tandem Mass ◽  
Over Time

Objective: Compare maximum concentration (Cmax), time to maximum concentration (Tmax), mean serum concentration of epinephrine, return of spontaneous circulation (ROSC), time to ROSC, and odds of survival relative to epinephrine administration by humerus intraosseous (HIO), tibial intraosseous (TIO), and intravenous (IV) routes in a swine cardiac arrest model.Design: Prospective, between subjects, randomized experimental design.Setting: TriService Research Facility.Subjects: Yorkshire-cross swine (n = 28).Intervention: Swine were anesthetized and placed into cardiac arrest. After 2 minutes, cardiopulmonary resuscitation was initiated. After an additional 2 minutes, a dose of 1 mg of epinephrine was administered by HIO, TIO, or the IV routes. Blood samples were collected over 4 minutes and analyzed by high-performance liquid chromatography tandem mass spectrometry.Main Outcome Measurements: ROSC, time to ROSC, Cmax, Tmax, mean concentrations over time, and odds ratio.Results: There was no significant difference in rate of the ROSC among the TIO, HIO, and IV groups (p 0.05). There were significant differences in Cmax: the HIO group was significantly higher than the TIO group (p = 0.007), but no significant difference between the IV and HIO (p = 0.33) or the IV and TIO group (p = 0.060). The Tmax was significantly shorter for both the IV and HIO versus the TIO group (p 0.05), but no difference between IV and HIO (p = 0.328). The odds of survival were higher in the HIO group compared to all other groups.Conclusion: The TIO and HIO provide rapid and reliable access to administer life-saving medications during 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.

Abstract 10522: Early Lactate Clearance is Associated With Survival in a National Cohort of Refractory Out-of-Hospital Cardiac Arrest Patients Managed With Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Emilie Gregers ◽  
Louise Linde ◽  
Sivagowry Moerk ◽  
Jo B Andreasen ◽  
morten smerup ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Lactate Level ◽  
Repeated Measures ◽  
Lactate Clearance ◽  
Low Flow ◽  
Whole Body ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Introduction: In refractory out-of-hospital cardiac arrest (OHCA), prolonged whole-body ischemia with global tissue injury proceeds even after achievement of reperfusion with extracorporeal cardiopulmonary resuscitation (eCPR). Hypothesis: Biomarkers reflecting ischemia and inflammation may be used for prognostication of refractory OHCA managed with eCPR. Methods: This nationwide retrospective study included patients (≥18 years) with refractory OHCA managed with eCPR in Denmark (2011 to 2020). Biomarker levels at admission, at 24 hours (lactate, leukocytes, and platelets), and repeated measures of lactate after eCPR initiation were analyzed. Lactate clearance was calculated as (admission lactate - post eCPR lactate) / admission lactate x100%. Results: Two hundred eighteen patients (80% male; age 52±12yrs) were included. Primary cause of OHCA was acute myocardial infarction (63%), 69% had shockable primary rhythm and 86% witnessed OHCA with a median low-flow time of 105 minutes (Q1-Q3: 86-124 min.). Fifty-three (24%) survived to hospital discharge. Survivors had a significantly lower lactate level at admission (13.1 vs. 15.4 mmol/l, p=0.004) and after 24 hours (2.8 vs. 5.0, p=0.001), and a significantly higher admission platelet level (181 vs. 153 x10 9 /l, p=0.03). No difference in admission levels of leukocytes nor leukocytes and platelets after 24 hours were found between survivors and non-survivors. Lactate clearance was available for 68% and 79% of patients alive after 8 and 24 hours, respectively. All survivors had a lactate level less than admission lactate at 8 hours (lactate clearance >0%) and had cleared >25% of admission lactate at 24 hours after eCPR initiation. There was a significant difference in survival between quartiles of lactate clearance at 8 hours after eCPR initiation (Figure 1). Conclusion: In conclusion, early lactate clearance after eCPR initiation was associated with survival to discharge in refractory OHCA-patients.

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