title: Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study.
abstract: BACKGROUND
  Despite improvements in pre-hospital and post-arrest critical care, sudden cardiac arrest (CA) remains one of the leading causes of death. Improving circulation during cardiopulmonary resuscitation (CPR) may improve survival rates and long-term clinical outcomes after CA.
  
  
  METHODS
  In a porcine model, we compared standard CPR (sCPR; n =10) with CPR using an intravascular cardiac assist device without additional chest compressions (iCPR; n =10) following 10 minutes of electrically induced ventricular fibrillation (VF). In a separate crossover experiment, 10 additional pigs were subjected to 10 minutes of VF and 6 minutes of sCPR; the iCPR device was then implanted if a return of spontaneous circulation (ROSC) was not achieved using sCPR. Animals were evaluated in respect to intra- and post-arrest hemodynamics, survival, functional outcome and cerebral and myocardial lesions following CPR. We hypothesized that iCPR would result in more frequent ROSC and better functional recovery than sCPR.
  
  
  RESULTS
  iCPR produced a mean flow of 1.36 ± 0.02 L/min, leading to significantly higher coronary perfusion pressure (CPP) values during the early period of CPR (22 ± 10 mmHg vs. 9 ± 5 mmHg, P ≤0.01, 1 minute after start of CPR; 20 ± 11 mmHg vs. 10 ± 7 mmHg, P =0.03, 2 minutes after start of CPR), resulting in high ROSC rates (100% in iCPR vs. 50% in sCPR animals; P =0.03). iCPR animals showed significantly lower serum S100 levels at 10 and 30 minutes following ROSC (3.5 ± 0.6 ng/ml vs. 7.4 ± 3.0 ng/ml 30 minutes after ROSC; P ≤0.01), as well as superior clinical outcomes based on overall performance categories (2.9 ± 1.0 vs. 4.6 ± 0.8 on day 1; P ≤0.01). In crossover experiments, 80% of animals required treatment with iCPR after failed sCPR. Notably, ROSC was still achieved in six of the remaining eight animals (75%) after a total of 22.8 ± 5.1 minutes of ischemia.
  
  
  CONCLUSIONS
  In a model of prolonged cardiac arrest, the use of iCPR instead of sCPR improved CPP and doubled ROSC rates, translating into improved clinical outcomes.
authors.affiliation: Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany. mderwall@ukaachen.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Derwall
authors.affiliation: Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany. abruecken@ukaachen.de.
authors.forename: Anne
authors.initials: A
authors.lastname: Brücken
authors.affiliation: Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany. cbleilevens@ukaachen.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Bleilevens
authors.affiliation: Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany. andreas.ebeling@rwth-aachen.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ebeling
authors.affiliation: Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany. philipp.foehr@gmail.com.
authors.forename: Philipp
authors.initials: P
authors.lastname: Föhr
authors.affiliation: Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany. rrossaint@ukaachen.de.
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.affiliation: Division of Cardiology, University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA. kernk@email.arizona.edu.
authors.forename: Karl B
authors.initials: KB
authors.lastname: Kern
authors.affiliation: Abiomed Europe GmbH, Neuenhofer Weg 3, Aachen, D-52074, Germany. cnix@abiomed.com.
authors.forename: Christoph
authors.initials: C
authors.lastname: Nix
authors.affiliation: Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany. mfries@ukaachen.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Fries
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods*; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D008297:Male; D015996:Survival Rate; D013552:Swine; D014693:Ventricular Fibrillation / Q000150:complications