From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
ASAIO J. 2018 Jul/Aug;64(4):489-496. doi: 10.1097/MAT.0000000000000694.
Maintaining adequate organ perfusion during cardiac arrest remains a challenge, and various assist techniques have been evaluated. We assessed whether a right ventricular impeller assist device (RVAD) in adjunct to a left ventricular impeller assist device (LVAD) is beneficial. Twenty anesthetized pigs were randomized to maximized circulatory support by percutaneously implanted left- or biventricular assist device(s) during 30 minutes of electrically induced ventricular fibrillation followed by three attempts of cardioversion. Continuous hemodynamic variables were recorded. Cardiac output and myocardial, cerebral, renal, and ileum mucosa tissue perfusion were measured with fluorescent microspheres, and repeated blood gas analyses were obtained. With biventricular support, an increased LVAD output was found compared with left ventricular (LV) support; 3.2 ± 0.2 (SEM) vs. 2.0 ± 0. 2 L/minute just after start of ventricular fibrillation, 3.2 ± 0.1 vs. 2.0 ± 0.1 L/minute after 15 minutes, and 3.0 ± 0.1 vs. 2.1 ± 0.1 L/minute after 30 minutes of cardiac arrest (pg < 0.001). Biventricular support also increased aortic and LV pressure, in addition to end-tidal CO2. Tissue blood flow rates were increased for most organs with biventricular support. Blood gas analyses showed improved oxygenation and lower s-lactate values. However, myocardial perfusion was degraded with biventricular support and return of spontaneous circulation less frequent (5/10 vs. 10/10; p = 0.033). Biventricular support was associated with high intraventricular pressure and decreased myocardial perfusion pressure, correlating significantly with flow rates in the LV wall. A transmural flow gradient was observed for both support modes, with better maintained subepicardial than midmyocardial and subendocardial perfusion.
在心脏骤停期间维持足够的器官灌注仍然是一个挑战，已经评估了各种辅助技术。我们评估了在电诱导的心室颤动期间通过经皮植入左心室或双心室辅助装置（LVAD）辅助的右心室叶轮辅助装置（RVAD）是否有益。在 30 分钟的电诱导心室颤动后，将 20 只麻醉猪随机分为通过经皮植入的左或双心室辅助装置（LVAD）最大化循环支持，随后进行三次电复律尝试。连续记录血流动力学变量。通过荧光微球测量心输出量和心肌、脑、肾和回肠黏膜组织灌注，并重复进行血气分析。与左心室支持相比，双心室支持发现 LVAD 输出增加；心室颤动开始后即刻为 3.2±0.2（SEM）与 2.0±0.2L/分钟，15 分钟后为 3.2±0.1 与 2.0±0.1L/分钟，30 分钟后为 3.0±0.1 与 2.1±0.1L/分钟（pg<0.001）。双心室支持还增加了主动脉和 LV 压力，以及呼气末 CO2。大多数器官的组织血流率随着双心室支持而增加。血气分析显示氧合改善，s-乳酸值降低。然而，双心室支持导致心肌灌注恶化，自主循环恢复的频率降低（5/10 与 10/10；p=0.033）。双心室支持与高室内压力和降低的心肌灌注压相关，与 LV 壁的流量显著相关。两种支持模式都观察到跨壁流量梯度，心外膜下灌注比中层和心内膜下灌注更好地维持。
