Coronary blood flow produced by muscle contractions induced by intracardiac electrical CPR during ventricular...

Area of Science:

• Cardiology
• Emergency Medicine
• Biomedical Engineering

Background:

• Transthoracic electrical cardiopulmonary resuscitation (ECPR) has demonstrated efficacy in generating coronary perfusion pressures (CPP) similar to manual chest compressions (MCC).
• The potential of intracardiac ECPR to achieve comparable CPP remains an area for investigation.

Purpose of the Study:

• To investigate whether intracardiac ECPR can produce CPP similar to MCC.
• To compare CPP generated by different intracardiac ECPR stimulation protocols (skeletal-based vs. cardiac-based) against historical MCC data.

Main Methods:

• ECPR pulse train protocols were applied using a defibrillator housing electrode and a right ventricular coil in a porcine model after 10 seconds of ventricular fibrillation (VF).
• Protocols involved 200-ms electrical pulse trains at 100 pulse trains/min for 20 seconds, categorized as skeletal-based or cardiac-based stimulation.
• Coronary perfusion pressure (CPP) was measured and compared to historical MCC values; success was defined as CPP > 15 mm Hg at 30 seconds of VF.

Main Results:

• The mean CPP for all intracardiac ECPR protocols at 30 seconds of VF was 14.8 ± 3.8 mm Hg.
• Successful skeletal-based IC-ECPR protocols yielded a mean CPP of 19.4 ± 3.2 mm Hg, while successful cardiac-based protocols yielded 17.4 ± 2.1 mm Hg.
• These results were not statistically different when compared to historical MCC data (P = 0.35 for skeletal-based, P = 0.08 for cardiac-based).

Conclusions:

• Intracardiac electrical CPR effectively produced observable skeletal muscle contractions and measurable pressure pulses.
• The study demonstrated that intracardiac ECPR can achieve coronary perfusion pressures similar to manual chest compressions during brief untreated ventricular fibrillation.