From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science.
ASAIO J. 2020 Nov/Dec;66(10):1110-1119. doi: 10.1097/MAT.0000000000001146.
Mechanical assist devices in refractory cardiac arrest are increasingly employed. We compared the hemodynamics and organ perfusion during cardiac arrest with either veno-arterial extracorporeal membrane oxygenation (ECMO) or biventricular assisted circulation combining left- and right-sided impeller devices (BiPella) in an acute experimental setting. Twenty pigs were randomized in two equal groups receiving circulatory support either by ECMO or by BiPella during 40 minutes of ventricular fibrillation (VF) followed by three attempts of cardioversion, and if successful, 60 minute observation with spontaneous, unsupported circulation. Hemodynamic variables were continuously recorded. Tissue perfusion was evaluated by fluorescent microsphere injections. Cardiac function was visualized by intracardiac echocardiography. During VF device output, carotid flow, kidney perfusion, mean aortic pressure (AOPmean), and mean left ventricular pressure (LVPmean) were all significantly higher in the ECMO group, and serum-lactate values were lower compared with the BiPella group. No difference in myocardial or cerebral perfusion was observed between groups. In 15 animals with sustained cardiac function for 60 minutes after return of spontaneous circulation, left ventricular subendocardial blood flow rate averaged 0.59 ± 0.05 ml/min/gm during VF compared with 0.31 ± 0.07 ml/min/gm in five animals with circulatory collapse (p = 0.005). Corresponding values for the midmyocardium was 0.91 ± 0.06 vs. 0.65 ± 0.15 ml/min/gm (p = 0.085). Both BiPella and ECMO could sustain vital organ function. ECMO provided a more optimal systemic circulatory support related to near physiologic output. Myocardial tissue perfusion and sustained cardiac function were related to coronary perfusion pressure during VF, irrespective of mode of circulatory support.
在难治性心脏骤停中越来越多地使用机械辅助装置。我们在急性实验环境中比较了心肺复苏期间使用静脉-动脉体外膜肺氧合 (ECMO) 或结合左、右侧叶轮装置的双心室辅助循环 (BiPella) 时的血液动力学和器官灌注。20 头猪随机分为两组，在心室颤动 (VF) 40 分钟后分别接受 ECMO 或 BiPella 循环支持，随后进行 3 次电复律，如果成功，则进行 60 分钟的自主、无支持循环观察。连续记录血液动力学变量。通过荧光微球注射评估组织灌注。通过心内超声心动图评估心脏功能。在 VF 期间，与 BiPella 组相比，ECMO 组的颈动脉流量、肾脏灌注、平均主动脉压 (AOPmean) 和平均左心室压 (LVPmean) 均显著升高，血清乳酸值较低。两组间心肌或脑灌注无差异。在 15 只动物自主循环恢复后 60 分钟心功能持续的动物中，与 5 只循环衰竭动物相比，VF 期间左心室心内膜下血流率平均为 0.59±0.05ml/min/gm，而 0.31±0.07ml/min/gm (p = 0.005)。对应于心中层的值分别为 0.91±0.06 vs. 0.65±0.15ml/min/gm (p = 0.085)。BiPella 和 ECMO 均可维持重要器官功能。ECMO 提供了更优化的全身循环支持，与接近生理的输出相关。VF 期间心肌组织灌注和持续的心功能与冠脉灌注压有关，而与循环支持方式无关。
