title: Prolonged cardiac arrest and resuscitation by extracorporeal life support: favourable outcome without preceding anticoagulation in an experimental setting.
abstract: State-of-the-art cardiopulmonary resuscitation (CPR) restores circulation with inconsistent blood-flow and pressure. Extracorporeal life support (ECLS) following CPR opens the opportunity for "controlled reperfusion". In animal experiments investigating CPR with ECLS, systemic anticoagulation before induced cardiac arrest is normal, but a major point of dispute, since preliminary heparinization in patients undergoing unwitnessed cardiac arrest is impossible. In this study, we investigated options for ECLS after an experimental 15 minutes normothermic cardiac arrest, without preceding anticoagulation, in pigs. Neurological recovery was assessed by a scoring system, electroencephalography and brain magnetic resonance imaging. Additionally, brain histology was performed on day seven after cardiac arrest. We demonstrated that preliminary heparin administration was not necessary for survival or neurological recovery in this setting. Heparin flushing of the cannulae seemed sufficient to avoid thrombus formation. These findings may ease the way to using ECLS in patients with sudden cardiac arrest.
authors.affiliation: 1Heart Center Freiburg University, Freiburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Foerster
authors.forename: M
authors.initials: M
authors.lastname: D'Inka
authors.forename: F
authors.initials: F
authors.lastname: Beyersdorf
authors.forename: C
authors.initials: C
authors.lastname: Benk
authors.forename: T
authors.initials: T
authors.lastname: Nguyen-Thanh
authors.forename: I
authors.initials: I
authors.lastname: Mader
authors.forename: B
authors.initials: B
authors.lastname: Fritsch
authors.forename: C
authors.initials: C
authors.lastname: Ihling
authors.forename: K
authors.initials: K
authors.lastname: Mueller
authors.forename: C
authors.initials: C
authors.lastname: Heilmann
authors.forename: G
authors.initials: G
authors.lastname: Trummer
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000008:administration & dosage; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006323:Heart Arrest / Q000628:therapy*; D011897:Random Allocation; D013552:Swine; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: anticoagulation; extracorporeal life support; neurological recovery; resuscitation; sudden cardiac arrest