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Femoral Vessel Occlusion Enhances Cardiac and Cerebral Perfusion in a Porcine Model of Cardiac Arrest
Joshua Y Kim1, Benjamin Usry1, Maren L Downing2
1College of Medicine Medical University of South Carolina Charleston SC USA.
Insights
External femoral vessel occlusion (FVO) during cardiopulmonary resuscitation (CPR) significantly boosts blood pressure and organ perfusion. This technique enhances cardiac and cerebral blood flow, offering a promising new approach to improve survival rates from cardiac arrest.
Area of Science:
- Cardiovascular Research
- Emergency Medicine
- Physiology
Background:
- Cardiac arrest has a global mortality rate exceeding 85-90%.
- Current cardiopulmonary resuscitation (CPR) methods have limitations in effectively perfusing organs.
- Novel strategies are needed to improve outcomes, especially in resource-limited settings.
Purpose of the Study:
- To evaluate the efficacy of external femoral vessel occlusion (FVO) as an adjunct to CPR.
- To assess the impact of FVO on hemodynamic measures and organ perfusion during cardiac arrest.
- To determine if FVO can improve cardiac and cerebral blood flow in a large mammal model.
Main Methods:
- Thirteen adult Yorkshire pigs were used, instrumented for hemodynamic and electrophysiologic monitoring.
- Animals underwent either routine CPR (control, n=7) or CPR with FVO (experimental, n=6) for 30 minutes.
- Cardiac and cerebral perfusion were quantified using fluorescent microspheres; mean arterial pressure was the primary outcome.
Main Results:
- External FVO significantly increased mean arterial pressure during both native heart function and CPR.
- CPR with FVO resulted in significantly higher mean arterial pressure compared to CPR alone (49±9 vs 32±3 mmHg).
- CPR with FVO markedly enhanced cardiac (181 vs 80 MFI) and cerebral perfusion (119 vs 27 MFI) compared to CPR alone.
Conclusions:
- External femoral vessel occlusion is an effective adjunctive strategy during CPR.
- FVO significantly improves mean arterial pressure, cardiac perfusion, and cerebral perfusion.
- FVO presents a novel therapeutic opportunity to reduce morbidity and mortality associated with cardiac arrest.
Background:
Closed chest compressions during cardiopulmonary resuscitation (CPR) mechanically circulate blood to the organs during cardiac arrest, yet cardiac arrest remains among the most fatal diseases, with a mortality rate that exceeds 85% to 90% globally. Novel methodologies to improve organ perfusion, particularly in resource-restricted settings, are overdue. This study evaluated the efficacy of external femoral vessel occlusion (FVO) during CPR in a large mammal model.
Methods:
Thirteen adult Yorkshire pigs were instrumented with vascular and electrophysiologic monitoring lines. Hemodynamic measures and cardiac and cerebral perfusion in the pre- and postarrest conditions were quantified via fluorescent microspheres infused into the circulation. Control (n=7) animals underwent routine CPR, whereas experimental (n=6) animals received CPR and FVO via external compression to the femoral vessels during the entirety of the 30-minute resuscitative phase. The primary outcome was mean arterial pressure, and secondary outcomes included cerebral and cardiac perfusion.
Results:
During native heart function, external FVO demonstrated a significant increase in mean arterial pressure (73±3 versus 62±2 mm Hg, P<0.001). During cardiac arrest, animals undergoing CPR with FVO had a significantly higher mean arterial pressure compared with CPR alone (49±9 versus 32±3 mm Hg, P<0.001). CPR with FVO significantly increased cardiac (181 versus 80 mean fluorescence intensity, P=0.014) and cerebral perfusion (119 versus 27 mean fluorescence intensity, P<0.001).
Conclusions:
CPR with FVO significantly increased mean arterial pressure, cardiac perfusion, and cerebral perfusion over CPR alone. These findings suggest FVO may represent a novel adjunctive strategy and therapeutic opportunity to enhance cerebral and cardiac perfusion, thereby decreasing cardiac arrest morbidity and mortality.
