SESSION TITLE: Cardiovascular Disease Posters I
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: Survival to discharge from cardiac arrest in patients with an initial rhythm of pulseless electrical activity or asystole remains dismal despite adequate cardiopulmonary resuscitation (CPR) efforts. Successful use of extracorporeal membrane oxygenation (ECMO) in the management of out-of-hospital sudden cardiac arrest has been reported and has generated interest in its use as an adjunct therapy to traditional CPR. We tested the hypothesis that cardiopulmonary support via ECMO may result in return of spontaneous circulation (ROSC) in a porcine model of hypoxic cardiac arrest.
METHODS: Utilizing a porcine model of cardiac arrest, five 50 kg adult pigs were intubated and sedated with inhaled isoflurane. A 21 Fr 50 cm long Medtronic Bio-Medicus venous cannula was inserted via the femoral vein into the inferior vena cava to the level of the diaphragm. A 15 Fr 18 cm long Medtronic Bio-Medicus arterial cannula was inserted into the femoral artery. Pressure in the aortic arch and right atrium was measured with Millar catheters with coronary perfusion pressure (CPP) calculated as the difference between the two measured pressures. Hypoxemia was induced by ventilation with 100% nitrogen gas. Fifteen minutes after onset of arrest, ECMO was initiated with a Medtronic Bio-Console 550 and MaquetQuadrox adult oxygenator with pump speeds set for a mean flow of 40 ml/kg/min.
RESULTS: After a mean average of one minute of ECMO support, organized cardiac electrical activity resumed evidenced by deflections in right atrial pressure tracings. Ventricular fibrillation became evident after a mean average of three minutes of ECMO support which was then successfully defibrillated into sinus rhythm after an additional 5 minutes of ECMO support in all five pigs. Prior to defibrillation, the mean CPP provided by ECMO was 32 mm Hg at a pump speed of 2000 RPM. Two minutes after return of spontaneous circulation (ROSC), the ECMO pump was turned off with maintenance of sinus rhythm, with mean peak aortic pressures of 70 mm Hg, and mean CPP of 40 mm Hg.
CONCLUSIONS: Low to moderate flow ECMO support can successfully produce ROSC in a porcine model of hypoxemic asystole cardiac arrest without any additional resuscitative support. ECMO deserves further investigation as an adjunct support technology for the resuscitation of PEA and asystolic cardiac arrest.
CLINICAL IMPLICATIONS: Maintenance of cardiac blood flow via ECMO can maintain cardiac viabillity in a PEA model of arrest even in the abscence of oxygen support.
DISCLOSURE: The following authors have nothing to disclose: Steven Keller, Sarah Fink, Henry Halperin, Muz Zviman
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