title: Pulsatile venoarterial perfusion using a novel synchronized cardiac assist device augments coronary artery blood flow during ventricular fibrillation.
abstract: Patients with cardiogenic shock have a very high mortality. Here we report the first use of a percutaneous pulsatile cardiac assist device, based on a diagonal pump synchronized with the heart cycle by means of an electrocardiographic signal in adult pigs. Eight domestic pigs underwent mandatory ventilation. During sinus rhythm, there were no differences between pulsatile and nonpulsatile perfusion with regard to pulmonary artery pressure, pulmonary wedge pressure, central venous pressure, mean arterial pressure (MAP), mean pulse pressure, and mean coronary artery flow (CAF). After 2 min of complete cardiac arrest (ventricular fibrillation), circulatory support with the i-cor in venoarterial nonpulsatile extracorporeal membrane oxygenation (ECMO) mode (3 L/min) restored systemic circulation, with an increase of MAP to 78.3 mm Hg and CAF to 5.27 mL/min. After changing from ECMO settings to pulsatile mode (3 L/min, 75 bpm, pulse amplitude range 3500 rpm), MAP did not change significantly (75.6 mm Hg); however, CAF increased to 8.45 mL/min. After changing back to nonpulsatile mode, MAP remained stable (83.6 mm Hg), but CAF decreased to 4.85 mL/min. Thereafter, pulsatile cardiac assist was established with a reduced blood flow of 2.5 L/min, and the pulse amplitude range was extended to 4500 rpm. Under these conditions, MAP remained stable (71.0 mm Hg), but CAF significantly increased to 15.2 mL/min (P < 0.05). Percutaneous cardiac support using a venoarterial cardiac assist device equipped with a novel diagonal pump is able to restore and increase systemic and coronary circulation during ventricular fibrillation. Electrocardiographically triggered synchronized cardiac assist provides an additional increase of coronary artery flow. These promising results are to be confirmed in humans.
authors.affiliation: Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany.
authors.forename: Bodo
authors.initials: B
authors.lastname: Cremers
authors.forename: Andreas
authors.initials: A
authors.lastname: Link
authors.forename: Christian
authors.initials: C
authors.lastname: Werner
authors.forename: Holger
authors.initials: H
authors.lastname: Gorhan
authors.forename: Ivo
authors.initials: I
authors.lastname: Simundic
authors.forename: Georg
authors.initials: G
authors.lastname: Matheis
authors.forename: Bruno
authors.initials: B
authors.lastname: Scheller
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Ulrich
authors.initials: U
authors.lastname: Laufs
mesh_terms: D000818:Animals; D003326:Coronary Circulation / Q000502:physiology*; D004195:Disease Models, Animal; D004562:Electrocardiography / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006323:Heart Arrest / Q000628:therapy*; D006353:Heart-Assist Devices; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D011673:Pulsatile Flow / Q000502:physiology*; D011897:Random Allocation; D012016:Reference Values; D012680:Sensitivity and Specificity; D034421:Sus scrofa; D013552:Swine; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000628:therapy*
keywords: Cardiogenic shock; Coronary blood flow; Extracorporeal life support system; Extracorporeal membrane oxygenation; Nonpulsatile; Pulsatile; Synchronized cardiac assist