Left ventricular thrombus development during ventricular fibrillation and resolution during resuscitation in a swine model of sudden cardiac arrest

Budhram, Gavin; Mader, Timothy J.; Lutfy, Lucienne; Murman, David H.; Almulhim, Abdullah

doi:10.1016/j.resuscitation.2014.01.030

Cited by 16 publications

(16 citation statements)

References 23 publications

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“…In addition, the transient stasis of blood associated with cardiac arrest may also predispose to thrombosis in the arterial system. A novel swine model of cardiac arrest has consistent shown the development of LV thrombosis with resolution with resuscitation . The lack of additional clinical predictors of LV thrombus emphasizes the difficulty clinicians have in determining “at risk” patients and weighing risks and benefits of use of oral anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

“…A novel swine model of cardiac arrest has consistent shown the development of LV thrombosis with resolution with resuscitation. 13 The lack of additional clinical predictors of LV thrombus emphasizes the difficulty clinicians have in determining ''at risk'' patients and weighing risks and benefits of use of oral anticoagulation. The utilization of unfractionated heparin (UFH) postprocedure was associated with an increased risk of LV thrombus in our study.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST‐Segment Elevation Myocardial Infarction

Driesman

Hyder

Lang

et al. 2015

Clinical Cardiology

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Background The role of warfarin in anterior ST-segment elevation myocardial infarction (STEMI) complicated by left ventricular (LV) dysfunction in patients treated with primary percutaneous coronary intervention (PCI) and dual antiplatelet therapy (DAPT) is unclear. Warfarin may prevent cardioembolic events but significantly increases bleeding in the setting of DAPT. Hypothesis The incidence of LV thrombus in anterior STEMI patients treated with PCI is low and clinical predictors might be valuable in determining patents at risk. Methods We performed a retrospective, single center study of 687 consecutive patients with anterior STEMI treated with PCI from 2006 to 2013. Baseline variables were evaluated in 310 patients at high risk for LV thrombus based on echocardiographic criteria. Patients with definite, probable and no LV thrombus were compared by ANOVA, chi squared or T-test where appropriate. Logistic regression analysis was performed. Results The incidence of LV thrombus was 15% (n=47 probable/definite thrombus). Cardiac arrest was the only independent characteristic associated with increased risk of LV thrombus (OR 4.06, 1.3–12.7). Trends were observed for a lower risk in cardiogenic shock (OR 0.33, 0.10–1.05) and aspirin use at baseline (OR 0.43, 0.17–1.1). Treatment variables associated with LV thrombus included unfractionated heparin use post PCI (OR 2.43, 1.16–5.1), and use of balloon angioplasty without stent. Conclusions In contemporary practice with primary PCI, definite LV thrombus following anterior STEMI with LV dysfunction is challenging to predict. Further investigation is needed to determine if there is a subset of patients that should be treated with prophylactic warfarin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST‐Segment Elevation Myocardial Infarction

Driesman

Hyder

Lang

et al. 2015

Clinical Cardiology

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“…One study suggests that a diffuse endothelial damage may occur after CA [19] and the subsequent exposition of tissue factor is likely to be an important contributing mechanism to the post-arrest prothrombotic state [21]. Budrham et al detected left ventricular thrombus by transesophageal echocardiography (TEE) in 86% of swine within 6 minutes of untreated ventricular fibrillation [17]. Finally, in humans treated with standard CPR, Varriale et al reported echocardiographic detection of intracardiac thrombus at 20–30 minutes after cardiac arrest onset, a finding that will be uniformly associated with failed resuscitation [23].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to ischemic injury, endothelial damage, and intravascular coagulation may limit recovery of organ function after prolonged CA [17–23]. Intravascular coagulation during cardiac arrest was initially described by Crowell in 1955 [24].…”

Section: Introductionmentioning

confidence: 99%

Thrombolytic-Enhanced Extracorporeal Cardiopulmonary Resuscitation After Prolonged Cardiac Arrest

Spinelli

Davis

Ren

et al. 2016

Critical Care Medicine

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Objective To investigate the effects of the combination of extracorporeal cardiopulmonary resuscitation (ECPR) and thrombolytic therapy on the recovery of vital organ function after prolonged cardiac arrest. Design Laboratory investigation Setting University Laboratory Subjects Pigs Interventions Animals underwent 30-minute untreated ventricular fibrillation cardiac arrest followed by extracorporeal cardiopulmonary resuscitation (ECPR) for 6 hours. Animals were allocated into two experimental groups: t-ECPR, which received Streptokinase 1 MU and c-ECPR which did not receive Streptokinase. In both groups the resuscitation protocol included the following physiologic targets: mean arterial pressure (MAP) > 70 mmHg, Cerebral perfusion pressure (CerPP) > 50 mmHg, PaO2 150 ± 50 mmHg, PaCO2 40 ± 5 mmHg and core temperature 33 ± 1 °C. Defibrillation was attempted after 30 minutes of ECPR. Measurements and Main Results A cardiac resuscitability score was assessed on the basis of: success of defibrillation; return of spontaneous heart beat; weanability form ECPR; and left ventricular systolic function after weaning. The addition of thrombolytic to ECPR significantly improved cardiac resuscitability (3.7 ± 1.6 in t-ECPR vs 1.0 ± 1.5 in c-ECPR). Arterial lactate clearance was higher in t-ECPR than in c-ECPR (40 ± 15% VS 18 ± 21 %). At the end of the experiment, the intracranial pressure was significantly higher in c-ECPR than in t-ECPR. Recovery of brain electrical activity, as assessed by quantitative analysis of EEG signal, and ischemic neuronal injury on histopathologic examination did not differ between groups. Animals in t-ECPR group did not have increased bleeding complications, including intracerebral hemorrhages. Conclusions In a porcine model of prolonged cardiac arrest, thrombolytic-enhanced ECPR improved cardiac resuscitability and reduced brain edema, without increasing bleeding complications. However, early EEG recovery and ischemic neuronal injury were not improved.

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“…We assumed that these thrombi may be caused by pacemaker leads, and a coagulant trend associated with cardiac arrest accelerated thrombus development. The formation of intracardiac thrombus is known to complicate several low-flow cardiac states, including severe acute myocardial infarction, AF, and severe cardiomyopathy, which can lead to life-threatening circulatory arrest [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Fatal cardiac thromboembolism in a patient with a pacemaker during ureteroscopic lithotripsy for ureter stone: a case report

Chung

Chae

Kim

2015

Korean J Anesthesiol

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Intracardiac thrombosis is an infrequent and fatal complication in patients with an inserted pacemaker. A patient with an inserted pacemaker scheduled for ureter stone removal experienced cardiac arrest and cardiopulmonary resuscitation under general anesthesia. Echocardiography showed multiple intracardiac thrombi. Preoperative diagnostic workup including echocardiography for the detection of pacemaker lead thrombus, and the need for anticoagulation should be considered in patients with an inserted pacemaker and high-risk factors for thrombosis.

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Left ventricular thrombus development during ventricular fibrillation and resolution during resuscitation in a swine model of sudden cardiac arrest

Cited by 16 publications

References 23 publications

Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST‐Segment Elevation Myocardial Infarction

Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST‐Segment Elevation Myocardial Infarction

Thrombolytic-Enhanced Extracorporeal Cardiopulmonary Resuscitation After Prolonged Cardiac Arrest

Fatal cardiac thromboembolism in a patient with a pacemaker during ureteroscopic lithotripsy for ureter stone: a case report

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