Prolonged cardiac arrest and resuscitation by extracorporeal life support: favourable outcome without preceding anticoagulation in an experimental setting

Foerster, Katharina; D’Inka, M; Beyersdorf, Friedhelm; Benk, Christoph; Thanh, Thao Nguyen; Mader, Irina; Fritsch, Brita; Ihling, Christian; Mueller, Karl H.; Heilmann, Claudia; Trummer, Christian

doi:10.1177/0267659113495081

Cited by 18 publications

(19 citation statements)

References 35 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Bartos

Voicu

Matsuura

et al. 2017

JACC: Basic to Translational Science

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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.

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Section: Discussionmentioning

confidence: 99%

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

Bartos

Voicu

Matsuura

et al. 2017

JACC: Basic to Translational Science

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“…The following reperfusion period of 60 minutes was characterized by adapting the reperfusion conditions and the circulating blood according to the continuous and readily available monitoring (i.e., blood gas monitoring, arterial blood pressure, temperature measurement, mixed venous oxygen saturation etc.). Depending on the tested variable, up to 90% of the animals survived the experimental course with up to 90% of them indicating a complete neurological recovery (18,(21)(22)(23)(24).…”

Section: Methodsmentioning

confidence: 99%

Controlled automated reperfusion of the whole body after cardiac arrest

Trummer¹,

Benk²,

Beyersdorf³

2019

J. Thorac. Dis

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Background: Sudden circulatory arrest (CA) requiring cardiopulmonary resuscitation (CPR) has for decades been associated with high mortality and frequent neurological sequelae in the rarer survivors. The high mortality and morbidity are potentially related to a severe and global ischemia/reperfusion injury (IRI) of the whole body, especially the brain. Consequently, strategies to counteract this severe IRI may improve survival and neurological recovery of affected patients. Methods: Based on the target to limit IRI in single organs, suitable parameters and methods were composed to form a global treatment concept, the CARL method (controlled automated reperfusion of the whole body). The concept centers on extracorporeal circulation, enhanced with readily available online monitoring. It allows for targeted adaption of different parameters (i.e., blood pressure and flow, temperature, oxygen content, electrolytes) during the reperfusion process, in the sense of a controlled reperfusion. Parameters and elements of the CARL method were extensively tested in a chronic animal model. An appropriate medical device, the system configuration "CIRD 1.0" (Controlled Integrated Resuscitation Device) is approved to be applied to patients. Results: A set of parameters that support a limitation of a global IRI have been identified in over 250 animal experiments. Their specific targets and surveillance using adequate monitoring features are described. Using the CIRD in a single center, 14 patients with witnessed, but extremely prolonged CPR (51-120 minutes) have been treated with CARL. The outcome of these patients was favorable, with 7 of 14 patients regaining full consciousness and 6 of 7 allocated to Cerebral Performance Class (CPC) "1". Conclusions: CA followed by CPR is associated with a very high mortality and frequent neurological sequelae. Limiting the occurring severe and global IRI may be a key to an improved survival and neurological recovery. Therefore, the therapeutic approach of CARL, which stands for a personalized, comprehensive therapy based on a readily available set of monitoring data and diagnostic findings, has been developed. First experience in patients indicates beneficial effects that call for further studies in the field of CARL.

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“…This led to the evaluation of ECPR in porcine models of refractory VF/VT cardiac arrest. [35][36][37][38][39][40] Studies demonstrating early institution of ECPR after cardiac arrest led to rapid improvements in coronary blood flow, 35 carotid blood flow, 35,39 serum lactate concentration, 35 peripheral oxygenation, 35 neurological function, 36,40 and ROSC and survival from cardiac arrest. [36][37][38]40 The Minnesota Resuscitation Consortium (MRC) further demonstrated the benefit of a porcine model of acute coronary occlusion myocardial infarction leading to refractory cardiac arrest.…”

Section: Development Of Advanced Perfusion Strategiesmentioning

confidence: 99%

Enhancing cardiac arrest survival with extracorporeal cardiopulmonary resuscitation: insights into the process of death

Aufderheide

Kalra

Kosmopoulos

et al. 2021

Annals of the New York Academy of Sciences

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Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging method of cardiopulmonary resuscitation to improve outcomes from cardiac arrest. This approach targets patients with out-of-hospital cardiac arrest previously unresponsive and refractory to standard treatment, combining approximately 1 h of standard CPR followed by venoarterial extracorporeal membrane oxygenation (VA-ECMO) and coronary artery revascularization. Despite its relatively new emergence for the treatment of cardiac arrest, the approach is grounded in a vast body of preclinical and clinical data that demonstrate significantly improved survival and neurological outcomes despite unprecedented, prolonged periods of CPR. In this review, we detail the principles behind VA-ECMO-facilitated resuscitation, contemporary clinical approaches with outcomes, and address the emerging new understanding of the process of death and capability for neurological recovery.

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Prolonged cardiac arrest and resuscitation by extracorporeal life support: favourable outcome without preceding anticoagulation in an experimental setting

Cited by 18 publications

References 35 publications

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

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

Controlled automated reperfusion of the whole body after cardiac arrest

Enhancing cardiac arrest survival with extracorporeal cardiopulmonary resuscitation: insights into the process of death

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