Emergency cardiopulmonary bypass for resuscitation from prolonged cardiac arrest

Šafář, Peter; Abramson, Norman S.; Angelos, Mark G.; Cantadore, Rinaldo; Leonov, Yuval; Levine, Robert L.; Pretto, Ernesto A.; Reich, Harvey; Sterz, Fritz; Stezoski, S. William; Tisherman, Samuel A.

doi:10.1016/0735-6757(90)90298-e

Cited by 160 publications

(67 citation statements)

References 95 publications

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“…Three keynotes to treatment include recognizing the role of CPB to overcome myocardial stunning after prolonged CA with CPR-ALS [4], using transient hyperkalemia on CBP to convert intractable VF, and insights into improving brain recovery. Studies show that less than 10 minutes of experimental CA followed by normothermic CPB results in almost complete myocardial and neurologic recovery [7,8]. Conversely, after 15 minutes of CA, negligible (approximately 15%) survival has been reported with CPR-ALS alone [7,10,12], and this finding is consistent with the 19% survival reported in our model.…”

Section: Commentsupporting

confidence: 91%

“…Studies show that less than 10 minutes of experimental CA followed by normothermic CPB results in almost complete myocardial and neurologic recovery [7,8]. Conversely, after 15 minutes of CA, negligible (approximately 15%) survival has been reported with CPR-ALS alone [7,10,12], and this finding is consistent with the 19% survival reported in our model. Although CPB allowed 64% survival after unsuccessful CPR-ALS, it failed to prevent impaired neurologic recovery and thus agrees with previous CPB reports [7, 10 -12].…”

Section: Commentsupporting

confidence: 91%

“…Cardiopulmonary bypass (CPB) expands the time window for successful resuscitation after CA when compared with conventional CPR [6,7], as 80% to 100% survival and complete cardiac and neurologic recovery occur after 5 to 10 minutes of CA in dogs [7,8]. Time is a critical factor, as mortality increases substantially (approximately 80%) and no neurologic recovery occurs after CPR-advanced life support (CPR-ALS) after 12.5 minutes of no-flow CA [9].…”

Section: S Uccessful Cardiopulmonary Resuscitation (Cpr) After Cardiamentioning

confidence: 99%

“…However, after 15 minutes of CA, there is no survival with CPR-ALS and even though CPB allows approximately 25% to 80% survival, it fails to prevent severe neurologic damage [7, 10 -12]. Furthermore, despite the improvements conferred by CPB, intractable ventricular fibrillation (VF) after prolonged CA remains a survival barrier; it occurs in 20% to 50% of animals after CA arrest of 15 minutes, and results in 100% mortality from cardiogenic shock [7,11,13].…”

Section: S Uccessful Cardiopulmonary Resuscitation (Cpr) After Cardiamentioning

confidence: 99%

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Resuscitation After Prolonged Cardiac Arrest: Role of Cardiopulmonary Bypass and Systemic Hyperkalemia

Liakopoulos

Allen

Hristov

et al. 2010

The Annals of Thoracic Surgery

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Background. The purpose of this study was to determine (1) the role of emergency cardiopulmonary bypass (CPB) after prolonged cardiac arrest and failed cardiopulmonary resuscitation, and (2) the use of systemic hyperkalemia during CPB to convert intractable ventricular fibrillation (VF).Methods. Thirty-one pigs (34 ؎ 2 kg) underwent 15 minutes of cardiac arrest after induced VF, followed by 10 minutes of cardiopulmonary resuscitation-advanced life support. Peripheral CPB was used if cardiopulmonary resuscitation failed to restore stable circulation. Damage was assessed by evaluating hemodynamics, biochemical variables (creatine kinase-MB, neuron-specific enolase), neurologic deficit score, and brain magnetic resonance imaging.Results. Cardiopulmonary resuscitation alone was successful in only 19% (6 of 31 pigs). Cardiopulmonary bypass was initiated in 81% of animals (25 of 31 pigs) either for hypotension (5 of 25 pigs) or intractable VF (20 of 25 pigs). Defibrillation was successful in 7 of 20 animals during the first 10 minutes after initiating CPB.

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Section: Commentsupporting

confidence: 91%

Section: Commentsupporting

confidence: 91%

Section: S Uccessful Cardiopulmonary Resuscitation (Cpr) After Cardiamentioning

confidence: 99%

Section: S Uccessful Cardiopulmonary Resuscitation (Cpr) After Cardiamentioning

confidence: 99%

See 2 more Smart Citations

Resuscitation After Prolonged Cardiac Arrest: Role of Cardiopulmonary Bypass and Systemic Hyperkalemia

Liakopoulos

Allen

Hristov

et al. 2010

The Annals of Thoracic Surgery

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“…An opportunity for a breakthrough in resuscitation is use of extracorporeal support (E-CPR) for reperfusion, given that it can be used to optimize extra-cerebral physiology while also allowing immediate temperature control and administration of therapies that might not otherwise be tolerated [263][264][265][266]. Technical challenges to E-CPR are considerable.…”

mentioning

confidence: 99%

Brain Resuscitation in the Drowning Victim

Warner

Knape

2006

Handbook on Drowning

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. This manuscript is dedicated to the memory of Peter Safar, M.D. Peter Safar combined genius, incredible purpose, elegance, and humanism to move the collective fields of acute medicine to a new level. His work in resuscitation medicine, critical care, anesthesiology, emergency medicine, and disaster medicine saved countless lives. As a mentor he taught us a great deal. Peter left us with an important message-in both clinical care and research: namely, to always ask, "what is your intervention or research doing for the patient?" Whether physician or scientist, it is a critical message never to forget.Portions of this manuscript are being reproduced in the Handbook of Drowning. Bierens JJ (ed.). Springer, 2nd Edition. NIH Public Access AbstractDrowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32-34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating nonconvulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific postresuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/ reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders.

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Improved Myocardial Function Using Cardiopulmonary Support in Resuscitation for Hemorrhagic Shock

Iguidbashian

Follette²,

Contino³

et al. 1994

Arch Surg

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Emergency cardiopulmonary bypass for resuscitation from prolonged cardiac arrest

Cited by 160 publications

References 95 publications

Resuscitation After Prolonged Cardiac Arrest: Role of Cardiopulmonary Bypass and Systemic Hyperkalemia

Resuscitation After Prolonged Cardiac Arrest: Role of Cardiopulmonary Bypass and Systemic Hyperkalemia

Brain Resuscitation in the Drowning Victim

Improved Myocardial Function Using Cardiopulmonary Support in Resuscitation for Hemorrhagic Shock

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