title: Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs.
abstract: Extracorporeal cardiopulmonary resuscitation (ECPR) is widely proposed for the treatment of refractory cardiac arrest. It should be associated with coronary angiography if coronary artery disease is suspected. However, the prioritization of care remains unclear in this situation. Our goal was to determine whether coronary reperfusion should be instituted as soon as possible in such situations in a pig model.
  
  
  
  Anesthetized pigs were instrumented and submitted to coronary artery occlusion and ventricular fibrillation. After 5 minutes of untreated cardiac arrest, conventional cardiopulmonary resuscitation (CPR) was started. Fifteen minutes later, ECPR was initiated for a total duration of 240 minutes. Animals randomly underwent either early or late coronary reperfusion at 20 or 120 minutes of ECPR, respectively. This timing was adapted to the kinetic of infarct extension in pigs. Return of spontaneous circulation was determined as organized electrocardiogram rhythm with systolic arterial pressure above 80 mm Hg. During conventional CPR, hemodynamic parameters were not different between groups. Carotid blood flow then increased by 70% after the onset of ECPR in both groups. No animal (0 of 7) elicited return of spontaneous circulation after late reperfusion versus 4 of 7 after early reperfusion (P=0.025). The hemodynamic parameters, such as carotid blood flow, were also improved in early versus late reperfusion groups (113±20 vs 43±17 mL/min after 240 minutes of ECPR, respectively; P=0.030), along with infarct size decrease (71±4% vs 84±2% of the risk zone, respectively; P=0.013).
  
  
  
  Early reperfusion improved hemodynamic status and facilitated return of spontaneous circulation in a porcine model of ischemic cardiac arrest treated by ECPR.
authors.affiliation: Inserm, U955, Equipe 03, Créteil, France.|Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.|Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.|Département d'Anesthésie Réanimation, Hôpital Universitaire Necker-Enfants Malades, SAMU de Paris, Université Paris Descartes-Paris V, Paris, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Hutin
authors.affiliation: Département d'Anesthésie Réanimation, Hôpital Universitaire Necker-Enfants Malades, SAMU de Paris, Université Paris Descartes-Paris V, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Lamhaut
authors.affiliation: Inserm, U955, Equipe 03, Créteil, France.|Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.|Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Lidouren
authors.affiliation: Inserm, U955, Equipe 03, Créteil, France.|Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.|Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kohlhauer
authors.affiliation: Inserm, U955, Equipe 03, Créteil, France.|Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.|Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.|Service d'Anesthésie et des Réanimations Chirurgicales, Réanimation Chirurgicale Cardio-vasculaire, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mongardon
authors.affiliation: Département d'Anesthésie Réanimation, Hôpital Universitaire Necker-Enfants Malades, SAMU de Paris, Université Paris Descartes-Paris V, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
authors.affiliation: Inserm, U955, Equipe 03, Créteil, France.|Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.|Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Berdeaux
authors.affiliation: Inserm, U955, Equipe 03, Créteil, France.|Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.|Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.
authors.forename: Bijan
authors.initials: B
authors.lastname: Ghaleh
authors.affiliation: Inserm, U955, Equipe 03, Créteil, France rtissier@vet-alfort.fr.|Université Paris Est UMR_S955, DHU A-TVB, UPEC, Créteil, France.|Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Tissier
mesh_terms: D000818:Animals; D001794:Blood Pressure; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery; D004562:Electrocardiography; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006439:Hemodynamics; D017202:Myocardial Ischemia / Q000150:complications / Q000628:therapy*; D015425:Myocardial Reperfusion; D034421:Sus scrofa; D013552:Swine; D014693:Ventricular Fibrillation / Q000209:etiology / Q000628:therapy*
keywords: 
  ECMO
  ; cardiac arrest; cardiopulmonary resuscitation; myocardial infarction; reperfusion