From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
ASAIO J. 2022 Apr 1;68(4):531-540. doi: 10.1097/MAT.0000000000001528.
This study evaluated the effects of extracorporeal membrane oxygenation (ECMO) in combination with a percutaneous adjunctive left ventricular assist device (LVAD) in a porcine model during 60 minutes of refractory cardiac arrest (CA). Twenty-four anesthetized swine were randomly allocated into three groups given different modes of circulatory assist: group 1: ECMO 72 ml/kg/min and LVAD; group 2: ECMO 36 ml/kg/min and LVAD; and group 3: ECMO 72 ml/kg/min. During CA and extracorporeal cardiopulmonary resuscitation (ECPR), mean left ventricular pressure (mLVP) was lower in group 1 (p = 0.013) and in group 2 (p = 0.003) versus group 3. Mean aortic pressure (mAP) and coronary perfusion pressure (CPP) were higher in group 1 compared with the other groups. In group 3, mean pulmonary artery flow (mPAf) was lower versus group 1 (p = 0.003) and group 2 (p = 0.039). If the return of spontaneous circulation (ROSC) was achieved after defibrillation, up to 180 minutes of unsupported observation followed. All subjects in groups 1 and 3, and 5 subjects in group 2 had ROSC. All subjects in group 1, five in group 2 and four in group 3 had sustained cardiac function after 3 hours of spontaneous circulation. Subjects that did not achieve ROSC or maintained cardiac function post-ROSC had lower mAP (p < 0.001), CPP (p = 0.002), and mPAf (p = 0.004) during CA and ECPR. Add-on LVAD may improve hemodynamics compared with ECMO alone during refractory CA but could not substitute reduced ECMO flow. Increased mAP and CPP could be related to ROSC rate and sustained cardiac function. Increased mLVP was related to poor post-ROSC cardiac function.
本研究评估了体外膜肺氧合（ECMO）联合经皮左心室辅助装置（LVAD）在 60 分钟难治性心脏骤停（CA）猪模型中的作用。24 只麻醉猪被随机分为三组，分别给予不同的循环辅助模式：组 1：ECMO 72ml/kg/min 和 LVAD；组 2：ECMO 36ml/kg/min 和 LVAD；组 3：ECMO 72ml/kg/min。在 CA 和体外心肺复苏（ECPR）期间，组 1（p=0.013）和组 2（p=0.003）的平均左心室压（mLVP）低于组 3。组 1 的平均主动脉压（mAP）和冠状动脉灌注压（CPP）高于其他组。组 3 的平均肺动脉流量（mPAf）低于组 1（p=0.003）和组 2（p=0.039）。如果除颤后恢复自主循环（ROSC），则进行长达 180 分钟的无支持观察。组 1 和组 3 的所有动物以及组 2 的 5 只动物均出现 ROSC。组 1 中的所有动物、组 2 中的 5 只动物和组 3 中的 4 只动物在自主循环 3 小时后均保持心脏功能。未出现 ROSC 或 ROSC 后维持心脏功能的动物在 CA 和 ECPR 期间的 mAP（p<0.001）、CPP（p=0.002）和 mPAf（p=0.004）较低。与单独 ECMO 相比，在难治性 CA 期间添加 LVAD 可能改善血液动力学，但不能替代降低的 ECMO 流量。mAP 和 CPP 的增加可能与 ROSC 率和持续的心脏功能有关。mLVP 的增加与 ROSC 后心脏功能不良有关。
