title: Feasibility of initiating extracorporeal life support during mechanical chest compression CPR: a porcine pilot study.
abstract: BACKGROUND
  Recently, portable extracorporeal membrane oxygenation (ECMO) machines have become commercially available. This creates the potential to utilize extracorporeal life support (ECLS) for the treatment of sudden cardiac arrest in the emergency department, and potentially in the out-of-hospital setting.
  
  
  OBJECTIVE
  We sought to determine the feasibility of installing the ECMO circuit during delivery of mechanical chest compression CPR.
  
  
  METHODS
  We used 5 mixed-breed domestic swine with a mean mass of 26.0 kg. After induction of anesthesia, animals were instrumented with micromanometer-tipped transducers placed in the aorta and right atrium via the left femoral artery and vein. Ventricular fibrillation (VF) was induced electrically with a transthoracic shock and left untreated for 8 min. Then, mechanical chest compressions were begun (LUCAS, Jolife, Lund, Sweden) and manual ventilations were performed to maintain ETCO(2) between 35 and 45Torr. Compressions continued until ECMO flow was started. Ten minutes after induction of VF, drugs were given (epinephrine, vasopressin, and propranolol). ECMO installation was started via cutdown on the right external jugular vein and right femoral artery for placement of venous and arterial catheters while chest compressions continued. ECMO installation start time varied from 17 to 30 min after start of compressions and continued until ECG indicated a shockable rhythm. First rescue shocks were given at 22, 32, 35, 44, and 65 min.
  
  
  RESULTS
  ECMO was successfully installed in all five animals without incident. It was necessary to briefly discontinue chest compressions during the most delicate part of inserting the catheters into the vessels. ECMO also allowed for very rapid cooling of the animals and facilitated post-resuscitation hemodynamic support. Only the 65-min animal did not attain return of spontaneous circulation (ROSC).
  
  
  CONCLUSIONS
  Mechanical chest compression may be a suitable therapeutic bridge to the installation of ECMO and does not interfere with ECMO catheter placement.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, USA. menegazzijj@upmc.edu
authors.forename: James J
authors.initials: JJ
authors.lastname: Menegazzi
authors.forename: David D
authors.initials: DD
authors.lastname: Salcido
authors.forename: Greggory J
authors.initials: GJ
authors.lastname: Housler
authors.forename: Eric S
authors.initials: ES
authors.lastname: Logue
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004195:Disease Models, Animal; D005112:Extracorporeal Circulation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006336:Heart Massage / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D010865:Pilot Projects; D012121:Respiration, Artificial / Q000379:methods; D013552:Swine; D013909:Thorax / Q000503:physiopathology; D016896:Treatment Outcome