Cremers Bodo, Link Andreas, Werner Christian, Gorhan Holger, Simundic Ivo, Matheis Georg, Scheller Bruno, Böhm Michael, Laufs Ulrich
Klinik für Innere Medizin III-Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany.
Artif Organs. 2015 Jan;39(1):77-82. doi: 10.1111/aor.12413. Epub 2014 Dec 16.
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.
心源性休克患者的死亡率非常高。在此，我们报告首次在成年猪中使用经皮搏动性心脏辅助装置，该装置基于一个对角泵，通过心电图信号与心动周期同步。八只家猪接受了强制通气。在窦性心律期间，搏动性灌注和非搏动性灌注在肺动脉压、肺楔压、中心静脉压、平均动脉压（MAP）、平均脉压和平均冠状动脉血流量（CAF）方面没有差异。在完全心脏骤停（室颤）2分钟后，采用静脉-动脉非搏动性体外膜肺氧合（ECMO）模式（3升/分钟）的i-cor进行循环支持恢复了体循环，MAP升至78.3毫米汞柱，CAF升至5.27毫升/分钟。从ECMO设置转换为搏动性模式（3升/分钟，75次/分钟，脉冲幅度范围3500转/分钟）后，MAP没有显著变化（75.6毫米汞柱）；然而，CAF增加到8.45毫升/分钟。换回非搏动性模式后，MAP保持稳定（83.6毫米汞柱），但CAF降至4.85毫升/分钟。此后，以2.5升/分钟的减少血流量建立搏动性心脏辅助，脉冲幅度范围扩展至4500转/分钟。在这些条件下，MAP保持稳定（71.0毫米汞柱），但CAF显著增加至15.2毫升/分钟（P<0.05）。使用配备新型对角泵的静脉-动脉心脏辅助装置进行经皮心脏支持能够在室颤期间恢复并增加体循环和冠状动脉循环。心电图触发的同步心脏辅助可额外增加冠状动脉血流量。这些有前景的结果有待在人体中得到证实。
