Author + information
- Received March 15, 2019
- Revision received April 29, 2019
- Accepted May 14, 2019
- Published online September 16, 2019.
- Kapildeo Lotun, MDa,
- Huu Tam Truong, MDa,
- Kyoung-Chul Cha, MD, PhDb,
- Hanan Alsakka, MSa,
- Renan Gianotto-Oliveira, MDc,
- Nicole Smith, MDa,
- Prashant Rao, MDa,
- Tyler Bien, BSa,
- Shaun Chatelain, DOa,
- Matthew C. Kern, BSa,
- Chiu-Hsieh Hsu, PhDd,
- Mathias Zuercher, MDe and
- Karl B. Kern, MDa,∗ (, )@KernKB
- aDepartment of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona
- bDepartment of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju-si, Republic of Korea
- cDepartment of Medicine, Heart Institute (InCor), School of Medicine, Sao Paulo University, Sao Paulo, Brazil
- dUniversity of Arizona College of Public Health, Tucson, Arizona
- eDepartment of Anesthesiology, University of Basel, Basel, Switzerland
- ↵∗Address for correspondence:
Dr. Karl B. Kern, Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Tucson, Arizona 85724.
Objectives The aim of this study was to evaluate the optimal treatment approach for cardiac arrest (CA) occurring in the cardiac catheterization laboratory.
Background CA can occur in the cath lab during high-risk percutaneous coronary intervention. While attempting to correct the precipitating cause of CA, several options are available to maintain vital organ perfusion. These include manual chest compressions, mechanical chest compressions, or a percutaneous left ventricular assist device.
Methods Eighty swine (58 ± 10 kg) were studied. The left main or proximal left anterior descending artery was occluded. Ventricular fibrillation (VFCA) was induced and circulatory support was provided with 1 of 4 techniques: either manual chest compressions (frequently interrupted), mechanical chest compressions with a piston device (LUCAS-2), an Impella 2.5 L percutaneously placed LVAD, or the combination of mechanical chest compressions and the percutaneous left ventricular assist device. The study protocol included 12 min of left main coronary occlusion, reperfusion, with defibrillation attempted after 15 min of VFCA. Primary outcome was favorable neurological function (CPC 1 or 2) at 24 h, while secondary outcomes included return of spontaneous circulation and hemodynamics.
Results Manual chest compressions provided fewer neurologically intact surviving animals than the combination of a mechanical chest compressor and a percutaneous LVAD device (0% vs. 56%; p < 0.01), while no difference was found between the 2 mechanical approaches (28% vs. 35%: p = 0.75). Comparing integrated coronary perfusion pressure showed sequential improvement in hemodynamic support with mechanical devices (401 ± 230 vs. 1,337 ± 905 mm Hg/s; p = 0.06).
Conclusions Combining 2 mechanical devices provided superior 24-h survival with favorable neurological recovery compared with manual compressions during moderate duration VFCA associated with an acute coronary occlusion in the animal catheterization laboratory.
- cardiac arrest
- coronary angiography and intervention
- mechanical support
- myocardial perfusion
- systemic perfusion
Dr. Kern was supported by funding from Physio-Control Inc. (investigator-initiated research project) and the Steven M. Gootter Foundation (Tucson, Arizona); and has served as a science advisory board member and received an investigator-initiated research project from Physio-Control Inc., which markets the LUCAS device. Dr. Lotun has served on the new product development advisory board for Abiomed, which markets the Impella Device; has served as a proctor for Medtronic; and is on the Speakers Bureau for LivaNova. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 15, 2019.
- Revision received April 29, 2019.
- Accepted May 14, 2019.
- 2019 American College of Cardiology Foundation
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