Severe Myocardial Dysfunction after Non-Ischemic Cardiac Arrest: Effectiveness of Percutaneous Assist Devices

Journal of Clinical Medicine

Andreas Goetzenich¹  Christoph Nix¹  Alain Cohen-Solal²  Stéphane Manzo-Silberman²  Pierre Demondion³  Guillaume Lebreton³  Pascal Leprince³  Michel Bonneau⁴  Chantal Kang⁴ 

[1] Abiomed Europe GmbH, Neuenhofer Weg 3, D-52074 Aachen, Germany;Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Denis Diderot University, INSERM UMRS 942, 75010 Paris, France;Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France;XP-MED, 78100 Saint Germain en Laye, France;

关键词: acute heart failure;    cardiogenic shock;    physiopathology;    mechanical circulatory support;    organ replacement therapies;    extracorporeal membrane oxygenation;   

DOI  :  10.3390/jcm10163623

来源: DOAJ

【 摘 要 】

Introduction: Despite the improvements in standardized cardiopulmonary resuscitation, survival remains low, mainly due to initial myocardial dysfunction and hemodynamic instability. Our goal was to compare the efficacy of two left ventricular assist devices on resuscitation and hemodynamic supply in a porcine model of ventricular fibrillation (VF) cardiac arrest. Methods: Seventeen anaesthetized pigs had 12 min of untreated VF followed by 6 min of chest compression and boluses of epinephrine. Next, a first defibrillation was attempted and pigs were randomized to any of the three groups: control (n = 5), implantation of an percutaneous left ventricular assist device (Impella, n = 5) or extracorporeal membrane oxygenation (ECMO, n = 7). Hemodynamic and myocardial functions were evaluated invasively at baseline, at return of spontaneous circulation (ROSC), after 10–30–60–120–240 min post-resuscitation. The primary endpoint was the rate of ROSC. Results: Only one of 5 pigs in the control group, 5 of 5 pigs in the Impella group, and 5 of 7 pigs in the ECMO group had ROSC (p < 0.05). Left ventricular ejection fraction at 240 min post-resuscitation was 37.5 ± 6.2% in the ECMO group vs. 23 ± 3% in the Impella group (p = 0.06). No significant difference in hemodynamic parameters was observed between the two ventricular assist devices. Conclusion: Early mechanical circulatory support appeared to improve resuscitation rates in a shockable rhythm model of cardiac arrest. This approach appears promising and should be further evaluated.

【 授权许可】

Unknown