Feasibility of initiating extracorporeal life support during mechanical chest compression CPR: A porcine pilot study

Abstract

Background Recently, portable extracorporeal membrane oxygenation (ECMO) machines have become commercially available. This creates the potential to utilize extracorporeal life support (ECLS) for the treatment of sudden cardiac arrest in the emergency department, and potentially in the out-of-hospital setting. Objective We sought to determine the feasibility of installing the ECMO circuit during delivery of mechanical chest compression CPR. Methods We used 5 mixed-breed domestic swine with a mean mass of 26.0 kg. After induction of anesthesia, animals were instrumented with micromanometer-tipped transducers placed in the aorta and right atrium via the left femoral artery and vein. Ventricular fibrillation (VF) was induced electrically with a transthoracic shock and left untreated for 8 minutes. Then, mechanical chest compressions were begun (LUCAS, Jolife, Lund, Sweden) and manual ventilations were performed to maintain ETCO2 between 35-45 torr. Compressions continued until ECMO flow was started. Ten minutes after induction of VF, drugs were given (epinephrine, vasopressin, and propranolol). ECMO installation was started via cutdown on the right external jugular vein and right femoral artery for placement of venous and arterial catheters while chest compressions continued. ECMO installation start time varied from 17 to 30 minutes after start of compressions and continued until ECG indicated a shockable rhythm. First rescue shocks were given at 22, 32, 35, 44, and 65 minutes. Results ECMO was successfully installed in all five animals without incident. It was necessary to briefly discontinue chest compressions during the most delicate part of inserting the catheters into the vessels. ECMO also allowed for very rapid cooling of the animals and facilitated post-resuscitation hemodynamic support. Only the 65-minute animal did not attain return of spontaneous circulation (ROSC). Conclusion Mechanical chest compression may be a suitable therapeutic bridge to the installation of ECMO and does not interfere with ECMO catheter placement.

Inducibility of ventricular fibrillation during mild therapeutic hypothermia: electrophysiological study in a swine model

“…The number of experimental animals tested is low, however multiple pairwise comparisons in individual animals counterbalances this limitation. The speed of cooling comparing ECMO cardiopulmonary resuscitation protocols [ 48 ] was considerably lower. Unlike them, we used a half ECMO flow (40 mL/kg/min) to prevent a hyperkinetic circulation in respect to spontaneous hemodynamics and also the priming the ECMO circuit with the precooled saline could not be applied before.…”

Role of Epinephrine and Extracorporeal Membrane Oxygenation in the Management of Ischemic Refractory Ventricular Fibrillation

“…Several previously published studies have evaluated ECMO as a resuscitation tool in different animal models of CA 10 , 11 , 12 , 13 , 14 , 15 , 16 . They found improved clinical outcomes using ECMO, but the experimental models did not attempt to reproduce refractory CA triggered by acute myocardial infarction.…”

Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

“…Experimental data on porcine models proved that automatic chest compression does not interfere with extracorporeal life support systems that can be successfully installed during chest compression [73]. In an extensive study on 4868 OHCA patients out of which 285 received automated mechanical compression with the use of an automated external chest compression device, the device proved to be easy to use, being installed on average in thirty seconds [74].…”