Selective aortic arch perfusion during cardiac arrest: A new resuscitation technique

Manning, James E.; Murphy, Charles; Hertz, Caryn M; Perretta, Sebastian G.; Mueller, Robert A.; Norfleet, Edward A.

doi:10.1016/s0196-0644(05)80645-6

Cited by 50 publications

(28 citation statements)

References 19 publications

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“…Selective aortic arch perfusion (SAAP) is a technique wherein an aortic occlusion balloon with a large central lumen is deployed in the high thoracic aorta to allow retrograde instillation of a perfusate directly into the aortic arch to achieve return of spontaneous circulation after cardiac arrest (28). Variations of SAAP incorporating aortic cross-clamps and a cardiopulmonary bypass circuit have been successfully employed during elective operations requiring circulatory arrest (29).…”

Section: Endovascular Methods For Achieving Aortic Occlusionmentioning

confidence: 99%

“…However, advances in catheter design now allow for this technique to be achieved endovascularly, with the administration of blood products and medications directly into the aortic arch through a central lumen in an aortic occlusion balloon. Translational experiments of medical and traumatic cardiac arrest demonstrate endovascular SAAP may result in return of spontaneous circulation faster and more reliably than chest compressions combined with intravenous perfusate administration (28, 30). …”

Section: Endovascular Methods For Achieving Aortic Occlusionmentioning

confidence: 99%

“…Injury to proximal organs from supraphysiologic blood pressure and flow, including pulmonary edema, cerebral edema, and elevated right heart pressures have been seen during periods of SAAP as short as 2 minutes (28). The more proximally positioned SAAP occlusion balloon may result in ischemia to the thoracic spinal cord and distal abdominal organs with prolonged balloon occlusion.…”

Section: Endovascular Methods For Achieving Aortic Occlusionmentioning

confidence: 99%

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Emerging Endovascular Therapies for Non-Compressible Torso Hemorrhage

Russo

Neff

Johnson

et al. 2016

Shock

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Management of non-compressible torso hemorrhage (NCTH) remains a challenge despite continued advancements in trauma resuscitation. Resuscitative thoracotomy with aortic cross-clamping and recent advances in endovascular aortic occlusion, including resuscitative endovascular occlusion of the aorta (REBOA), have finite durations of therapy due to the inherent physiologic stressors that accompany complete occlusion. Here we attempt to illuminate the current state of aortic occlusion for trauma resuscitation including: 1) explanation of the deleterious consequences of complete occlusion, 2) potential methods and limitations of existing technology to overcome these consequences, 3) a description of innovative methods to improve the resuscitation of NCTH. By explaining the complexity and potential deleterious effects of resuscitation augmented with aortic occlusion, our goal is to provide practitioners with a real-world perspective on current endovascular technology and to encourage the continued innovation required to overcome existing obstacles.

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Section: Endovascular Methods For Achieving Aortic Occlusionmentioning

confidence: 99%

Section: Endovascular Methods For Achieving Aortic Occlusionmentioning

confidence: 99%

Section: Endovascular Methods For Achieving Aortic Occlusionmentioning

confidence: 99%

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Emerging Endovascular Therapies for Non-Compressible Torso Hemorrhage

Russo

Neff

Johnson

et al. 2016

Shock

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“…This scenario was applied because medical staff, including paramedics, are taught to perform endotracheal intubation, which is the gold standard for airway management during CPR. Moreover, the importance of providing uninterrupted CCs is emphasised because every interruption causes a dramatic decrease in coronary perfusion pressure [26]. Among the strengths of the research, one should mention the comparison of three different CC techniques, including the authors' new method, as well as the randomised crossover nature of the study.…”

Section: Limitations Of the Studymentioning

confidence: 99%

The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial

et al. 2017

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A b s t r a c tBackground: The aetiology of sudden cardiac arrest in infants is different from that in adults, with respiratory failure, sudden infant death syndrome, and drowning being the primary causes in the former. According to the European Resuscitation Council (ERC) and American Heart Association (AHA) recommendations, the quality of chest compressions (CC) is a key element affecting the effectiveness of cardiopulmonary resuscitation (CPR). The current ERC and AHA guidelines recommend the 'two-finger technique' (TFT) or 'two-thumb encircling hands technique' (TTHT) for external CCs during infant CPR. Aim:The aim of the randomised crossover manikin trial was to assess the CC quality during simulated resuscitation in infants performed by paramedics. Methods:A prospective, randomised, crossover, single-centre study was conducted between June and August 2016. The study material consisted of 120 fully trained and licensed paramedics (39 females, 32.5%) with a minimum of five years of professional experience (mean 7.5 ± 4.8 years) in emergency medicine (mean age, 30.5 ± 5.5 years). The participants performed CCs using three techniques: TFT (the rescuer compresses the sternum with the tips of two fingers); TTHT; and the 'new two-thumb technique' (nTTT). The novel method of CCs in an infant consists of using two thumbs directed at the angle of 90 degrees to the chest while closing the fingers of both hands in a fist. Results:The median CC rate when using the TFT, the TTHT, and nTTT methods varied and amounted to 134 min -1 vs. 126 min -1 vs. 114 min -1 , respectively. There was a statistically significant difference in the median CC frequency between TFT and TTHT (p < 0.001), TFT and nTTT (p < 0.001), and between TTHT and nTTT (p < 0.001). The highest percentage of compressions with the frequency recommended by the ERC guidelines (100-120 min -1 ) was achieved by the study participants only with the nTTT. The median CC depth during the TFT was 28 mm (interquartile range [IQR] 27-30 mm) and was significantly lower than in the static . In all scenarios, the correct placement of the CC point was achieved in more than 90% of cases. Conclusions:Our novel infant CC method provides the highest percentage of CCs with the frequency recommended by the ERC guidelines as compared with standard techniques. It also allows optimal CC depth.

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“…In dieser Zeit wird eine spezielle Lösung durch den Katheter infundiert, wodurch selektiv vor allem Herz und Gehirn duchblutet werden. Unklar ist, mit welchem "Cocktail" und wie lange diese selektive Perfusion von Herz und Gehirn durchgeführt werden sollte [32]. Diese interessante CPR-Methode wird wahrscheinlich aufgrund der aufwendigen Instrumentierung kaum in die Praxis umsetzbar sein.…”

Section: Kombination Von Acd Cpr Und Abdominaler Kompression/dekompreunclassified

Neue mechanische Methoden der kardiopulmonalen Reanimation (CPR)

Lindner

Wenzel

1997

Der Anaesthesist

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In a recent German multicenter study, 25% of the patients who suffered a witnessed cardiac arrest outside the hospital were resuscitated successfully and were discharged from the hospital. Approximately 100,000 people suffer a fatal cardiac arrest in Germany annually, which is about ten times more than deaths resulting from motor vehicle accidents. New devices and techniques for cardiopulmonary resuscitation (CPR) have been developed in order to enhance the efficacy of chest compressions during CPR. The purpose of the present article is to review mechanisms of blood flow during CPR, to discuss CPR devices and techniques (vest CPR, CPR with interposed abdominal compressions, active compression-decompression (ACD) CPR, phased chest and abdominal compression-decompression CPR, and to further evaluate results from subsequently published laboratory and clinical studies. Vest CPR performs chest compressions with a pneumatic pump, which is able to compress the entire thorax with great force while minimizing injury. This device was developed to achieve an optimal driving force of the thoracic-pump mechanism during CPR. After promising results in laboratory studies and further technical development, vest CPR increased coronary perfusion pressure (CPP) in a clinical study even after 45 min of unsuccessful advanced cardiac life support. Currently, this device is being evaluated in an international multicenter study in Europe and the United States. A vest for employment by the emergency medical service (EMS) is in preparation. Interposed abdominal compressions during relaxation of the chest may augment artificial blood flow. In some laboratory studies, this mechanism resulted, in part, in promising data, and in another did not achieve better survival rates in comparison with standard CPR. No benefit of abdominal compressions was shown in an investigation in an EMS, whereas in a clinical study patients who were treated with interposed abdominal compressions were more likely to survive and be discharged from the hospital. However, in a follow-up study of in-hospital patients with asystole or pulseless electrical activity, abdominal compressions resulted in higher 24-h survival, but not hospital discharge rate, when compared with standard CPR. In animal studies ACD CPR produced increased CPP, end-tidal carbon dioxide, minute ventilation, and short-term survival. Subsequently performed clinical studies confirmed the data from the laboratory investigations; however, the hemodynamic advantage of ACD CPR did not result in increased long-term survival and a better neurological outcome in both in- and out-of-hospital cardiac arrest patients. To date, the reason why better hemodynamic variables did not result in better outcomes is unknown. A combination of ACD CPR with interposed abdominal compressions raised cerebral blood flow by approximately 60%, but did not augment myocardial blood flow in comparison with standard CPR. Recently, a device was developed to administer phased chest and abdominal compression-decompression CPR; this te...

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Selective aortic arch perfusion during cardiac arrest: A new resuscitation technique

Cited by 50 publications

References 19 publications

Emerging Endovascular Therapies for Non-Compressible Torso Hemorrhage

Emerging Endovascular Therapies for Non-Compressible Torso Hemorrhage

The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial

Neue mechanische Methoden der kardiopulmonalen Reanimation (CPR)

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