Severe Myocardial Dysfunction after Non-Ischemic Cardiac Arrest: Effectiveness of Percutaneous Assist Devices
Journal of Clinical Medicine, vol. 10, pp. 3623
Abstract
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.
Authors 8
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Inserm · Assistance Publique – Hôpitaux de Paris · Hôpital Lariboisière · Marqueurs cardiovasculaires en situation de stress
Affiliation as printed
Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Denis Diderot University, INSERM UMRS 942, 75010 Paris, France
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Abiomed (Germany) · European X-Ray Free-Electron Laser
Affiliation as printed
Abiomed Europe GmbH, Neuenhofer Weg 3, D-52074 Aachen, Germany
European XFEL Gmbh (Albert Einstein Ring 19, D-22761 Hamburg - Germany)
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Abiomed (Germany) · European X-Ray Free-Electron Laser
Affiliation as printed
Abiomed Europe GmbH, Neuenhofer Weg 3, D-52074 Aachen, Germany
European XFEL Gmbh (Albert Einstein Ring 19, D-22761 Hamburg - Germany)
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Sorbonne Université · Assistance Publique – Hôpitaux de Paris · Pitié-Salpêtrière Hospital
Affiliation as printed
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
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Affiliation as printed
XP-MED, 78100 Saint Germain en Laye, France
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Inserm · Assistance Publique – Hôpitaux de Paris · Hôpital Lariboisière · Marqueurs cardiovasculaires en situation de stress
Affiliation as printed
Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Denis Diderot University, INSERM UMRS 942, 75010 Paris, France
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Sorbonne Université · Assistance Publique – Hôpitaux de Paris · Pitié-Salpêtrière Hospital
Affiliation as printed
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
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Sorbonne Université · Assistance Publique – Hôpitaux de Paris · Pitié-Salpêtrière Hospital
Affiliation as printed
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
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