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

Abstract

CONDENSED ABSTRACT xtracorporeal membrane oxygenation (ECMO) is used in cardiopulmonary resuscitation (CPR) of refractory cardiac arrest. We used a 2×2 study design to compare ECMO versus CPR and epinephrine versus placebo in a porcine model of ischemic refractory ventricular fibrillation (VF). Pigs underwent 5 minutes of untreated VF, 10 minutes of CPR, and were randomized to receive epinephrine versus placebo for another 35 minutes. Animals were further randomized to LAD reperfusion at minute 45 with ongoing CPR versus veno-arterial ECMO cannulation at minute 45 of CPR and subsequent LAD reperfusion. Four-hour survival was improved with ECMO while epinephrine showed no effect.

Management of Refractory Ventricular Fibrillation

“…Bartos et al. (45) observed the best survival in animals in the Epi−/ECMO+ group followed by the Epi+/ECMO+ group. The Epi+/ECMO− group fared the worst.…”

“…In this issue of JACC: Basic to Translational Science , Bartos et al. (45) use a 2-by-2 factorial design to evaluate the role of ECMO and IV epinephrine in a pig model of refractory VF. This was done to simulate patients with out-of-hospital refractory VF receiving early transport to the cardiac catheterization laboratory and ECMO-facilitated coronary revascularization compared with routine CPR-based revascularization without ECMO, and to control for concurrent use of IV epinephrine.…”

“…A limitation of the excellent work by Bartos et al. (45) is that to simulate refractory VF, defibrillation was not administered to the animals until 45 min from arrest, which is later than is common in patients. The success of defibrillation and survival may have been different in animals receiving epinephrine versus placebo.…”

“…Given the benefit of ECMO and lack of benefit of IV epinephrine observed by Bartos et al. (45) , such efforts might focus on mechanical circulatory support rather than IV vasopressor therapy.…”

Venoarterial Extracorporeal Membrane Oxygenation Increased Immune Function of Spleen and Decreased Reactive Oxygen Species During Post‐Resuscitation

“…More than 350 000 and 300 000 individuals experience CA yearly in North America and Europe, respectively . Although cardiopulmonary resuscitation (CPR) is a widely known procedure and is used to save the lives of patients with CA, return of spontaneous circulation (ROSC) and survival rate in CA patients treated with conventional cardiopulmonary resuscitation (CCPR) is very low . Persistently poor outcomes have triggered interest in a modified approach to CA management as the second line of treatment.…”