Abstract 13290: Achieving Return of Spontaneous Circulation After Failed Standard Resuscitation using a Percutaneous Left-ventricular Assist Device in a Porcine Cardiac Arrest Model
Introduction: We previously demonstrated superiority of a left-ventricular-assist device (LVAD) over conventional cardiopulmonary resuscitation (CPR) when the device was implanted pre-arrest.
Hypothesis: Establishing optimized hemodynamics via LVAD following prolonged CA and failed CPR allows for a return of spontaneous circulation (ROSC).
Methods: Four pigs were instrumented with an arterial line and a pulmonary artery catheter. CA was electrically induced and left untreated for 10 minutes before CPR was performed employing mechanical chest compressions and mechanical ventilation. After 6 minutes of CPR, a single defibrillation was attempted. When no ROSC was achieved, chest compressions were ceased, and an LVAD (Impella 2.5, Abiomed, Danvers, MA) percutaneously introduced into the left ventricle. The LVAD was started at maximum flow as soon as the correct placement was verified. Following four minutes of LVAD circulation, defibrillation was attempted. If ROSC was achieved, hemodynamic values were recorded for 2 h before anesthesia was discontinued to allow for crude neurologic evaluation.
Results: Although MAP rose from 15 ± 1 to 26 ± 3 mmHg during CPR (p<0.05) animals did not respond to defibrillation following six minutes of chest compressions. LVAD placement took 60 ± 42 seconds. On average, the LVAD delivered 1.5 ± 0.1 L/min (24 % of baseline CO) resulting in an increase in MAP from 21 ± 3 mmHg after 18 minutes of CA to 45 ± 11 mmHg (p=0.02) and a CPP of 21 ± 4 mmHg before the second defibrillation (see Figure ; * indicates p<0.01 for CPP at 19 vs. 22 min). While no animal achieved ROSC after conventional CPR, all (n=4) animals could be successfully resuscitated using the LVAD. All animals were able to swallow and breathe spontaneously. Presence of pupillary light-, and corneal reflexes as well spontaneous movements of all four limbs were present.
Conclusion: Placement of a percutaneous LVAD following unsuccessful standard CPR could be rapidly achieved and enabled ROSC.
- © 2013 by American Heart Association, Inc.