Effects of interventional lung assist on haemodynamics and gas exchange in cardiopulmonary resuscitation: a prospective experimental study on animals with acute respiratory distress syndrome.
BACKGROUND
Interventional lung assist (ILA), based on the use of a pumpless extracorporeal membrane oxygenator, facilitates carbon dioxide (CO2) elimination in acute respiratory distress syndrome (ARDS). It is unclear whether an ILA system should be clamped during cardiopulmonary resuscitation (CPR) in patients with ARDS or not. The aim of our study was to test the effects of an ILA on haemodynamics and gas exchange during CPR on animals with ARDS and to establish whether the ILA should be kept open or clamped under these circumstances.


METHODS
The study was designed to be prospective and experimental. The experiments were performed on 12 anaesthetised and mechanically ventilated pigs (weighing 41 to 58 kg). One femoral artery and one femoral vein were cannulated and connected to an ILA. ARDS was induced by repeated bronchoalveolar lavage. An indwelling pacemaker was used to initiate ventricular fibrillation and chest compressions were immediately started and continued for 30 minutes. In six animals, the ILA was kept open and in the other six it was clamped.


RESULTS
Systolic and mean arterial pressures did not differ significantly between the groups. With the ILA open mean +/- standard deviation systolic blood pressures were 89 +/- 26 mmHg at 5 minutes, 71 +/- 28 mmHg at 10 minutes, 63 +/- 33 mmHg at 20 minutes and 83 +/- 23 mmHg at 30 minutes. The clamped ILA system resulted in systolic pressures of 77 +/- 30 mmHg, 90 +/- 23 mmHg, 72 +/- 11 mmHg and 72 +/- 22 mmHg, respectively. In the group with the ILA system open, arterial partial pressure of CO2 was significantly lower after 10, 20 and 30 minutes of CPR and arterial partial pressure of oxygen was higher 20 minutes after the onset of CPR (191 +/- 140 mmHg versus 57 +/- 14 mmHg). End-tidal partial pressure of CO2 decreased from 46 +/- 23 Torr (ILA open) and 37 +/- 9 Torr (ILA clamped) before intervention to 8 +/- 5 Torr and 8 +/- 10 Torr, respectively, in both groups after 30 minutes of CPR.


CONCLUSIONS
Our results indicate that in an animal model of ARDS, blood pressures were not impaired by keeping the ILA system open during CPR compared with the immediate clamping of the ILA with the onset of CPR. The effect of ILA on gas exchange implied a beneficial effect.
Zick
Günther
G
Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany. zick@anaesthesie.uni-kiel.de
Schädler
Dirk
D
Elke
Gunnar
G
Pulletz
Sven
S
Bein
Berthold
B
Scholz
Jens
J
Frerichs
Inéz
I
Weiler
Norbert
N
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005112:Extracorporeal Circulation / Q000379:methods; D006439:Hemodynamics / Q000502:physiology*; D010313:Partial Pressure; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology* / Q000628:therapy*; D013552:Swine