Controlled automated reperfusion of the whole body after 120 minutes of Cardiopulmonary resuscitation: first clinical report

Abstract

BackgroundCardiopulmonary resuscitation (CPR) is associated with a high mortality rate. Furthermore, the few survivors often have severe, persistent cerebral dysfunction. A potential cause for this unsatisfactory outcome after CPR is the combination of cardiac arrest (ischemia) and the inability to restore adequate hemodynamics during conventional CPR (reperfusion), resulting in ischemia/reperfusion injury of the whole body. Therefore we developed a concept counteracting this ischemia/reperfusion injury during the process of CPR.Case presentationWe present data from a patient, in whom the concept of a novel controlled automated reperfusion of the whole body (CARL) was applied after 120 min of CPR under normothermic conditions. The patient survived without cerebral deficits and showed full recovery of all organs after prolonged cardiac arrest (CA) except for the spinal cord, where a defect at the level of the 11th thoracic vertebra caused partial loss of motoric function of the legs.ConclusionThis is the first reported clinical application of CARL after CA. The implementation of CARL resulted in unexpected survival and recovery after prolonged normothermic CA and CPR. In synopsis with the preclinical experience in pigs this case shows, that the new concept of CARL treating ischemia/reperfusion during the CPR may be an important element within the future treatment of CA.Trial RegistrationTrial was retrospectively registered in the “German Clinical Trials Register” (www.germanctr.de) under No.: DRKS00005773 on July 28th, 2015.

European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care

“…controlled reperfusion of the whole body) have also demonstrated good neurological survival following 15-20 min of experimental cardiac arrest and in humans [260,261]. These concepts are currently also undergoing further clinical evaluation [262].…”

Controlled automated reperfusion of the whole body after cardiac arrest

“…Despite the extremely prolonged preceding periods of CPR between 51 and 120 minutes, 7 of 14 surviving patients regained full consciousness while 6 of these 7 were assigned to Cerebral Performance Class (CPC) "1". This complete cerebral recovery also applied to one patient of this series with the most extended preceding period of 120 minutes CPR, who returned to her former work despite a remaining paresis of the legs due to an arteria spinalis anterior syndrome (29).…”

Postreanimationsbehandlung

“…Sehr spezifische extrakorporale lebenserhaltende Konzepte (kontrollierte Reperfusion des gesamten Körpers) haben auch nach 15 bis 20 min experimentellen Kreislaufstillstands und auch beim Menschen gutes neurologisches Überleben gezeigt [263,264]. Diese Konzepte werden derzeit ebenfalls klinisch evaluiert [265].…”