Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study

Persistent Link:
http://hdl.handle.net/10150/610308
Title:
Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study
Author:
Derwall, Matthias; Brücken, Anne; Bleilevens, Christian; Ebeling, Andreas; Föhr, Philipp; Rossaint, Rolf; Kern, Karl B.; Nix, Christoph; Fries, Michael
Affiliation:
Klinik für Anästhesiologie, Uniklinik RWTH Aachen; Division of Cardiology, University of Arizona College of Medicine; Abiomed Europe GmbH
Issue Date:
2015
Publisher:
BioMed Central Ltd
Citation:
Derwall et al. Critical Care (2015) 19:123 DOI 10.1186/s13054-015-0864-2
Journal:
Critical Care
Rights:
© 2015 Derwall et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0
Collection Information:
This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.
Abstract:
INTRODUCTION: Despite improvements in pre-hospital and post-arrest critical care, sudden cardiac arrest (CA) remains one of the leading causes of death. Improving circulation during cardiopulmonary resuscitation (CPR) may improve survival rates and long-term clinical outcomes after CA. METHODS: In a porcine model, we compared standard CPR (sCPR; n =10) with CPR using an intravascular cardiac assist device without additional chest compressions (iCPR; n =10) following 10 minutes of electrically induced ventricular fibrillation (VF). In a separate crossover experiment, 10 additional pigs were subjected to 10 minutes of VF and 6 minutes of sCPR; the iCPR device was then implanted if a return of spontaneous circulation (ROSC) was not achieved using sCPR. Animals were evaluated in respect to intra- and post-arrest hemodynamics, survival, functional outcome and cerebral and myocardial lesions following CPR. We hypothesized that iCPR would result in more frequent ROSC and better functional recovery than sCPR. RESULTS: iCPR produced a mean flow of 1.36 ± 0.02 L/min, leading to significantly higher coronary perfusion pressure (CPP) values during the early period of CPR (22 ± 10 mmHg vs. 9 ± 5 mmHg, P ≤0.01, 1 minute after start of CPR; 20 ± 11 mmHg vs. 10 ± 7 mmHg, P =0.03, 2 minutes after start of CPR), resulting in high ROSC rates (100% in iCPR vs. 50% in sCPR animals; P =0.03). iCPR animals showed significantly lower serum S100 levels at 10 and 30 minutes following ROSC (3.5 ± 0.6 ng/ml vs. 7.4 ± 3.0 ng/ml 30 minutes after ROSC; P ≤0.01), as well as superior clinical outcomes based on overall performance categories (2.9 ± 1.0 vs. 4.6 ± 0.8 on day 1; P ≤0.01). In crossover experiments, 80% of animals required treatment with iCPR after failed sCPR. Notably, ROSC was still achieved in six of the remaining eight animals (75%) after a total of 22.8 ± 5.1 minutes of ischemia. CONCLUSIONS: In a model of prolonged cardiac arrest, the use of iCPR instead of sCPR improved CPP and doubled ROSC rates, translating into improved clinical outcomes.
EISSN:
1466-609X
DOI:
10.1186/s13054-015-0864-2
Version:
Final published version
Additional Links:
http://www.ccforum.com/content/19/1/123

Full metadata record

DC FieldValue Language
dc.contributor.authorDerwall, Matthiasen
dc.contributor.authorBrücken, Anneen
dc.contributor.authorBleilevens, Christianen
dc.contributor.authorEbeling, Andreasen
dc.contributor.authorFöhr, Philippen
dc.contributor.authorRossaint, Rolfen
dc.contributor.authorKern, Karl B.en
dc.contributor.authorNix, Christophen
dc.contributor.authorFries, Michaelen
dc.date.accessioned2016-05-20T09:03:50Z-
dc.date.available2016-05-20T09:03:50Z-
dc.date.issued2015en
dc.identifier.citationDerwall et al. Critical Care (2015) 19:123 DOI 10.1186/s13054-015-0864-2en
dc.identifier.doi10.1186/s13054-015-0864-2en
dc.identifier.urihttp://hdl.handle.net/10150/610308-
dc.description.abstractINTRODUCTION: Despite improvements in pre-hospital and post-arrest critical care, sudden cardiac arrest (CA) remains one of the leading causes of death. Improving circulation during cardiopulmonary resuscitation (CPR) may improve survival rates and long-term clinical outcomes after CA. METHODS: In a porcine model, we compared standard CPR (sCPR; n =10) with CPR using an intravascular cardiac assist device without additional chest compressions (iCPR; n =10) following 10 minutes of electrically induced ventricular fibrillation (VF). In a separate crossover experiment, 10 additional pigs were subjected to 10 minutes of VF and 6 minutes of sCPR; the iCPR device was then implanted if a return of spontaneous circulation (ROSC) was not achieved using sCPR. Animals were evaluated in respect to intra- and post-arrest hemodynamics, survival, functional outcome and cerebral and myocardial lesions following CPR. We hypothesized that iCPR would result in more frequent ROSC and better functional recovery than sCPR. RESULTS: iCPR produced a mean flow of 1.36 ± 0.02 L/min, leading to significantly higher coronary perfusion pressure (CPP) values during the early period of CPR (22 ± 10 mmHg vs. 9 ± 5 mmHg, P ≤0.01, 1 minute after start of CPR; 20 ± 11 mmHg vs. 10 ± 7 mmHg, P =0.03, 2 minutes after start of CPR), resulting in high ROSC rates (100% in iCPR vs. 50% in sCPR animals; P =0.03). iCPR animals showed significantly lower serum S100 levels at 10 and 30 minutes following ROSC (3.5 ± 0.6 ng/ml vs. 7.4 ± 3.0 ng/ml 30 minutes after ROSC; P ≤0.01), as well as superior clinical outcomes based on overall performance categories (2.9 ± 1.0 vs. 4.6 ± 0.8 on day 1; P ≤0.01). In crossover experiments, 80% of animals required treatment with iCPR after failed sCPR. Notably, ROSC was still achieved in six of the remaining eight animals (75%) after a total of 22.8 ± 5.1 minutes of ischemia. CONCLUSIONS: In a model of prolonged cardiac arrest, the use of iCPR instead of sCPR improved CPP and doubled ROSC rates, translating into improved clinical outcomes.en
dc.language.isoenen
dc.publisherBioMed Central Ltden
dc.relation.urlhttp://www.ccforum.com/content/19/1/123en
dc.rights© 2015 Derwall et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0en
dc.titleDoubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal studyen
dc.typeArticleen
dc.identifier.eissn1466-609Xen
dc.contributor.departmentKlinik für Anästhesiologie, Uniklinik RWTH Aachenen
dc.contributor.departmentDivision of Cardiology, University of Arizona College of Medicineen
dc.contributor.departmentAbiomed Europe GmbHen
dc.identifier.journalCritical Careen
dc.description.collectioninformationThis item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.en
dc.eprint.versionFinal published versionen
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