Randomised comparison of percutaneous left ventricular assist device with open-chest cardiac massage and with surgical assist device during ischaemic cardiac arrest

Tuseth, Vegard; Pettersen, Reidar J.; Grong, Ketil; Wentzel‐Larsen, Tore; Haaverstad, Rune; Fanneløp, Tord; Nordrehaug, Jan Erik

doi:10.1016/j.resuscitation.2010.06.008

Cited by 11 publications

(4 citation statements)

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“…Although the use of the Impella system has been extensively described in several cases of advanced cardiac failure [ 36 ], there are only a few reported studies of its use in the context of cardiac arrest, predominantly in post-cardiac arrest patients presenting with low cardiac output syndrome or recurring episodes of VF [ 37 ]. In three animal studies, Tuseth and colleagues showed that cerebral and myocardial perfusion could be significantly improved compared with open-chest cardiac compressions for up to 45 minutes [ 16 , 38 , 39 ]. However, they did not report whether this therapy had an influence on survival or neurological outcome in a closed-chest model of cardiac arrest and CPR.…”

Section: Discussionmentioning

confidence: 99%

“…Second, we did not directly measure cerebral or coronary blood flow during CPR, which has been extensively reported by Tuseth and colleagues in an open-chest cardiac arrest model [ 16 , 38 , 39 ]. However, because we decided to focus on resuscitation success and clinical outcomes, we were obliged to avoid invasive measurements that may have compromised survival itself.…”

Section: Discussionmentioning

confidence: 99%

“…The device is used to support patients during high-risk percutaneous interventions, post-cardiotomy heart failure and severe cardiogenic shock [ 15 ]. In previous experimental studies, researchers demonstrated superior perfusion of vital organs in a cardiac arrest setting in an open-chest pig model using the Impella 2.5 compared with direct cardiac compression [ 16 ]. Whether such a strategy could be superior to standard CPR (sCPR) in a closed-chest model with respect to improved CPR success rates and better neurological outcomes is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study

et al. 2015

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IntroductionDespite improvements in pre-hospital and post-arrest critical care, sudden cardiac arrest (CA) remains one of the leading causes of death. Improving circulation during cardiopulmonary resuscitation (CPR) may improve survival rates and long-term clinical outcomes after CA.MethodsIn a porcine model, we compared standard CPR (sCPR; n =10) with CPR using an intravascular cardiac assist device without additional chest compressions (iCPR; n =10) following 10 minutes of electrically induced ventricular fibrillation (VF). In a separate crossover experiment, 10 additional pigs were subjected to 10 minutes of VF and 6 minutes of sCPR; the iCPR device was then implanted if a return of spontaneous circulation (ROSC) was not achieved using sCPR. Animals were evaluated in respect to intra- and post-arrest hemodynamics, survival, functional outcome and cerebral and myocardial lesions following CPR. We hypothesized that iCPR would result in more frequent ROSC and better functional recovery than sCPR.ResultsiCPR produced a mean flow of 1.36 ± 0.02 L/min, leading to significantly higher coronary perfusion pressure (CPP) values during the early period of CPR (22 ± 10 mmHg vs. 9 ± 5 mmHg, P ≤0.01, 1 minute after start of CPR; 20 ± 11 mmHg vs. 10 ± 7 mmHg, P =0.03, 2 minutes after start of CPR), resulting in high ROSC rates (100% in iCPR vs. 50% in sCPR animals; P =0.03). iCPR animals showed significantly lower serum S100 levels at 10 and 30 minutes following ROSC (3.5 ± 0.6 ng/ml vs. 7.4 ± 3.0 ng/ml 30 minutes after ROSC; P ≤0.01), as well as superior clinical outcomes based on overall performance categories (2.9 ± 1.0 vs. 4.6 ± 0.8 on day 1; P ≤0.01). In crossover experiments, 80% of animals required treatment with iCPR after failed sCPR. Notably, ROSC was still achieved in six of the remaining eight animals (75%) after a total of 22.8 ± 5.1 minutes of ischemia.ConclusionsIn a model of prolonged cardiac arrest, the use of iCPR instead of sCPR improved CPP and doubled ROSC rates, translating into improved clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study

et al. 2015

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“…Moreover, Tuseth et al (34) have shown in an experimental model that a percutaneous LV assist device can achieve hemodynamic support comparable to that of open chest cardiac massage during cardiac arrest.…”

Section: Acute Cardiac Carementioning

confidence: 99%

Highlights of the 2009 Scientific Sessions of the European Society of Cardiology

Bax

Casadei

Mario

et al. 2009

Journal of the American College of Cardiology

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The annual congress of the European Society of Cardiology (ESC) was held in Barcelona, Spain, August 29 to September 2, 2009. The total attendance was 31,323 participants from 136 different countries. Excellent congress facilities hosted 237 pre-arranged sessions in 30 meeting rooms running in parallel, including several joint sessions in collaboration with other societies (e.g., the American College of Cardiology, the American Heart Association, and the World Heart Federation). A total of 9,848 abstracts from 96 different countries was submitted, and 4,085 (42%) abstracts were selected for presentation. PreventionPrevention was the theme of this year's meeting, and interesting novelties were presented. From the Copenhagen City Heart Study, Jensen et al. (1) reported that the resting heart rate was linearly related to fibrinogen and highsensitivity C-reactive protein plasma levels. After adjustment for inflammatory markers, heart rate remained an independent risk factor for both cardiovascular (CV) and all-cause mortality: the relative risk (RR) for CV mortality was 1.2 (p Ͻ 0.001) for each 10 beats/min increase of heart rate.Among Ͼ300,000 French adults, Plichart et al. (2) found increments of 7 beats/min and 5 beats/min in resting heart rates in women and men, respectively, in the decade 1990 to 2000; no further change was noted in the last decade. This puzzling finding could not be explained by conventional risk factors, medication, or physical activity, and prognostic implications remain to be demonstrated.The outcome of the French law on a smoke-free environment in public places inspired Bura et al. (3) to study the effect of this law on employees in bars and restaurants. Comparison of 23 nonactive smokers exposed to passive smoking in the workplace (but not exposed at home) and 23 controls (exposed neither at work nor at home) showed a significant reduction in flow-mediated dilation (5.8% vs. 9.1%) before application of the law. This was almost normalized 4 months after the law was imposed: 8.3% versus 9.5%, illustrating the impact of smoking restriction on vascular function.Pereg et al. (4) evaluated the role of stress in patients with acute myocardial infarction (MI) and compared hair samples from 45 patients admitted for acute MI with samples from 45 patients admitted for noncardiac causes. The authors reported a significant increase in hair cortisol levels: 320 ng/g (range 102 to 937 ng/g) versus 231 ng/g (range 82 to 1,123 ng/g; p Ͻ 0.001), respectively. This observation suggests that infarct patients may have experienced chronic stress during the 3 months preceding the acute event.

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New Strategies to Improve Outcome After Cardiac Arrest

2013

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Randomised comparison of percutaneous left ventricular assist device with open-chest cardiac massage and with surgical assist device during ischaemic cardiac arrest

Cited by 11 publications

References 31 publications

Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study

Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study

Highlights of the 2009 Scientific Sessions of the European Society of Cardiology

New Strategies to Improve Outcome After Cardiac Arrest

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