Abstract P69: Feasibility of Initiating Cardiopulmonary Bypass During Mechanical Chest Compression CPR
Background: Recently, portable cardiopulmonary bypass (CPB) machines have become commercially available in Europe, with US availability pending. This creates the opportunity to utilize CPB for the treatment of out-of-hospital cardiac arrest (OOHCA).
Objective: We sought to determine the feasibility of installing the CPB circuit while mechanical chest compression CPR was being done.
Methods: We used 5 mixed-breed domestic swine with a mean mass of 26.0 kg. After induction of anesthesia, animals were instrumented with micromanometer-tipped transducers placed in the aorta and right atrium via the left femoral artery and vein. Ventricular fibrillation (VF) was induced electrically with a transthoracic shock and left untreated for 8 minutes. Then, mechanical chest compressions were begun (LUCAS, Jolife, Lund, Sweden) and manual ventilations were performed to maintain ETCO2 between 35–45 torr. Compressions continued until CPB flow was started. Ten minutes after induction of VF, drugs were given (epinephrine, vasopressin, and propranolol), and at 13 minutes installation of CPB was started via cutdown on the right external jugular vein and right femoral artery for placement of venous and arterial catheters. CPB start time varied from 17 to 30 minutes after start of compressions and continued until ECG indicated a shockable rhythm. First rescue shocks were given at 22, 32, 35, 44, and 65 minutes.
Results: CPB was successfully installed in all five animals without incident. It was necessary to briefly discontinue chest compressions during the most delicate part of inserting the catheters into the vessels. CPB also allowed for very rapid cooling of the animals and facilitated post-resuscitation hemodynamic support. Only the 65-minute animal did not attain ROSC.
Conclusion: Mechanical chest compression may be a suitable therapeutic bridge to the installation of CPB and does not interfere with CPB catheter placement.