Percutaneous left ventricular assist in ischemic cardiac arrest.
BACKGROUND
Ischemic cardiac arrest represents a challenge for optimal emergency revascularization therapy. A percutaneous left ventricular assist device (LVAD) may be beneficial.


OBJECTIVE
To determine the effect of a percutaneous LVAD during cardiac arrest without chest compressions and to assess the effect of fluid loading.


METHODS
Totally, 16 pigs randomized to either conventional or intensive fluid with LVAD support during ventricular fibrillation (VF).


METHODS
Acute experimental trial with pigs under general anesthesia.


METHODS
Farm pigs of both sexes.


METHODS
After randomization for fluid infusion, VF was induced by balloon occlusion of the proximal left anterior descending artery. LVAD and fluid were started after VF had been induced.


METHODS
Brain, kidney, myocardial tissue perfusion, and cardiac index were measured with the microsphere injection technique at baseline, 3, and 15 minutes. Additional hemodynamic monitoring continued until 30 minutes.


RESULTS
At 15 minutes, vital organ perfusion was maintained without significant differences between the two groups. Mean cardiac index at 3 minutes of VF was 1.2 L x min(-1) x m2 (29% of baseline, p < 0.05). Mean perfusion at 3 minutes was 65% in the brain and 74% in the myocardium compared with baseline (p < 0.05), then remained unchanged during the initial 15 minutes. At 30 minutes, LVAD function was sustained in 11 of 16 animals (8 of 8 intensified fluid vs. 3 of 8 conventional fluid) and was associated with intensified fluid loading (p < 0.001).


CONCLUSIONS
During VF, a percutaneous LVAD may sustain vital organ perfusion. A potential clinical role of the device during cardiac arrest has yet to be established.
Tuseth
Vegard
V
Department of Heart Disease, Haukeland University Hospital, N-5021 Bergen, Norway. vegard.tuseth@helse-bergen.no
Salem
Mohamed
M
Pettersen
Reidar
R
Grong
Ketil
K
Rotevatn
Svein
S
Wentzel-Larsen
Tore
T
Nordrehaug
Jan Erik
JE
D000818:Animals; D006323:Heart Arrest / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices; D017202:Myocardial Ischemia / Q000150:complications* / Q000503:physiopathology; D013552:Swine