Balanced Biventricular Assist Versus Extracorporeal Membrane Oxygenation in Cardiac Arrest
| Autor: | Rune Haaverstad, Liqun Zhang, Kjetil Halvorsen Løland, Atle Solholm, Lodve Stangeland, Arve Mongstad, Ketil Grong, Erik J S Packer, Grete Slettom, Jan Erik Nordrehaug, Vegard Tuseth, Tom Roar Omdal |
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| Rok vydání: | 2020 |
| Předmět: |
Cardiac function curve
medicine.medical_specialty Circulatory collapse Swine medicine.medical_treatment Biomedical Engineering Biophysics Bioengineering 030204 cardiovascular system & hematology Return of spontaneous circulation Biomaterials Random Allocation 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Internal medicine medicine Extracorporeal membrane oxygenation Animals Cerebral perfusion pressure business.industry Hemodynamics General Medicine medicine.disease Heart Arrest 030228 respiratory system Ventricular fibrillation Cardiology Ventricular pressure Coronary perfusion pressure Heart-Assist Devices business |
| Zdroj: | ASAIO Journal. 66:1110-1119 |
| ISSN: | 1058-2916 |
| DOI: | 10.1097/mat.0000000000001146 |
| Popis: | Mechanical assist devices in refractory cardiac arrest are increasingly employed. We compared the hemodynamics and organ perfusion during cardiac arrest with either veno-arterial extracorporeal membrane oxygenation (ECMO) or biventricular assisted circulation combining left- and right-sided impeller devices (BiPella) in an acute experimental setting. Twenty pigs were randomized in two equal groups receiving circulatory support either by ECMO or by BiPella during 40 minutes of ventricular fibrillation (VF) followed by three attempts of cardioversion, and if successful, 60 minute observation with spontaneous, unsupported circulation. Hemodynamic variables were continuously recorded. Tissue perfusion was evaluated by fluorescent microsphere injections. Cardiac function was visualized by intracardiac echocardiography. During VF device output, carotid flow, kidney perfusion, mean aortic pressure (AOPmean), and mean left ventricular pressure (LVPmean) were all significantly higher in the ECMO group, and serum-lactate values were lower compared with the BiPella group. No difference in myocardial or cerebral perfusion was observed between groups. In 15 animals with sustained cardiac function for 60 minutes after return of spontaneous circulation, left ventricular subendocardial blood flow rate averaged 0.59 ± 0.05 ml/min/gm during VF compared with 0.31 ± 0.07 ml/min/gm in five animals with circulatory collapse (p = 0.005). Corresponding values for the midmyocardium was 0.91 ± 0.06 vs. 0.65 ± 0.15 ml/min/gm (p = 0.085). Both BiPella and ECMO could sustain vital organ function. ECMO provided a more optimal systemic circulatory support related to near physiologic output. Myocardial tissue perfusion and sustained cardiac function were related to coronary perfusion pressure during VF, irrespective of mode of circulatory support. |
| Databáze: | OpenAIRE |
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