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Cardiac resuscitation by extracorporeal circulation after failure of conventional CPR
R J Gazmuri1, M H Weil, M von Planta
1Department of Medicine, University of Health Sciences, Chicago Medical School, IL 60064.
Insights
Venoarterial extracorporeal circulation (ECC) with epinephrine effectively resuscitated pigs after cardiac arrest when conventional CPR failed. This method offers a promising alternative for critical cardiac resuscitation interventions.
Area of Science:
- Cardiology
- Emergency Medicine
- Physiology
Background:
- Restoration of myocardial blood flow is critical after cardiac arrest.
- Conventional closed-chest CPR has limited hemodynamic efficiency.
- Venoarterial ECC with peripheral access is explored as an alternative resuscitation method.
Purpose of the Study:
- To investigate venoarterial ECC as an alternative for cardiac resuscitation.
- To compare the efficacy of ECC with epinephrine versus conventional CPR with epinephrine.
Main Methods:
- Ventricular fibrillation was induced in domestic pigs.
- Conventional closed-chest CPR was initiated after 10 minutes, followed by venoarterial ECC at 15 minutes.
- Epinephrine was administered with ECC and compared to sham ECC with precordial compression.
Main Results:
- ECC restored sinus rhythm in all eight pigs.
- Spontaneous circulation reestablished in 6/8 pigs after 152 minutes.
- ECC with epinephrine reestablished sinus rhythm and spontaneous circulation in all pigs within 23 minutes.
- ECC with epinephrine showed significantly higher resuscitation rates (p < 0.01) compared to sham ECC.
Conclusions:
- Venoarterial ECC combined with epinephrine is a highly effective resuscitation intervention.
- ECC with epinephrine surpasses conventional CPR and defibrillation when these methods fail.
- This experimental approach demonstrates significant promise for reversing cardiac arrest.
Abstract:
After cardiac arrest, return of cardiac function and effective circulation are contingent on prompt restoration of myocardial blood flow. Because conventional closed-chest CPR has limited hemodynamic efficiency, we investigated venoarterial ECC utilizing peripheral vascular access as an alternative for cardiac resuscitation. Ventricular fibrillation was induced in domestic pigs by alternating current delivered to the endocardium of the right ventricle. Conventional closed-chest CPR was begun after 10 minutes. In each instance, precordial compression and external defibrillation failed to restore a viable rhythm. ECC was begun at 15 minutes at an average flow rate of 183 ml/kg/min. In each of eight animals, sinus rhythm was restored. In six of these eight animals, spontaneous circulation was reestablished after an average interval of 152 minutes. When epinephrine was administered concomitantly with ECC in an additional eight animals so as to maintain mean aortic pressure between 60 and 100 mm Hg, sinus rhythm and spontaneous circulation were reestablished in each pig after an average of only 23 minutes. The effects of ECC in conjunction with epinephrine were then compared with those of conventional precordial compression in conjunction with epinephrine (sham ECC). In contrast to ECC, which successfully resuscitated each of five animals, none of five sham ECC-treated animals was resuscitated by continued precordial compression and maximal doses of epinephrine (p less than 0.01). We conclude that ECC in conjunction with epinephrine emerges as a highly effective experimental intervention for resuscitation when conventional techniques of precordial compression and external defibrillation fail to reverse cardiac arrest.