R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland.
Henry-Jackson Foundation, Bethesda, Maryland.
Shock. 2022 Jun 1;57(6):243-250. doi: 10.1097/SHK.0000000000001946.
Selective aortic arch perfusion (SAAP) is an endovascular technique that consists of aortic occlusion with perfusion of the coronary and cerebral circulation. It been shown to facilitate return of spontaneous circulation (ROSC) after exanguination cardiac arrest (ECA), but it is not known how long arrest may last before the myocardium can no longer be durably recovered. The aim of this study is to assess the myocardial tolerance to exsanguination cardiac arrest before successful ROSC with SAAP.
Male adult swine (n = 24) were anesthetized, instrumented, and hemorrhaged to arrest. Animals were randomized into three groups: 5, 10, and 15 min of cardiac arrest before resuscitation with SAAP. Following ROSC, animals were observed for 60 min in a critical care environment. Primary outcomes were ROSC, and survival at 1-h post-ROSC.
Shorter cardiac arrest time was associated with higher ROSC rate and better 1-h survival. ROSC was obtained for 100% (8/8) of the 5-min ECA group, 75% (6/8) of the 10-min group, 43% (3/7) of the 15-min group (P = 0.04). One-hour post-ROSC survival was 75%, 50%, and 14% in 5-, 10-, and 15-min groups, respectively (P = 0.02). One-hour survivors in the 5-min group required less norepinephrine (1.31 mg ± 0.83 mg) compared with 10-SAAP (0.76 mg ± 0.24 mg), P = 0.008.
Whole blood SAAP can accomplish ROSC at high rates even after 10 min of unsupported cardiac arrest secondary to hemorrhage, with some viability beyond to 15 min. This is promising as a tool for ECA, but requires additional optimization and clinical trials.Animal Use Protocol, IACUC: 0919015.
选择性主动脉弓灌注（SAAP）是一种血管内技术，包括主动脉闭塞和冠状动脉及脑循环灌注。它已被证明可以促进失血性心脏骤停（ECA）后自主循环（ROSC）的恢复，但尚不清楚心肌在无法持久恢复之前可以停止多长时间。本研究旨在评估使用 SAAP 成功恢复 ROSC 之前，心肌对 ECA 的耐受程度。
雄性成年猪（n=24）麻醉、仪器操作和出血致心跳骤停。动物随机分为三组：SAAP 复苏前心脏骤停 5、10 和 15 分钟。ROSC 后，动物在重症监护环境中观察 60 分钟。主要结局是 ROSC 和 ROSC 后 1 小时的存活率。
心脏骤停时间越短，ROSC 率越高，1 小时存活率越好。5 分钟 ECA 组 100%（8/8）获得 ROSC，10 分钟组 75%（6/8），15 分钟组 43%（3/7）（P=0.04）。ROSC 后 1 小时存活率分别为 75%、50%和 14%，5-、10-和 15-分钟组（P=0.02）。5 分钟组的 1 小时幸存者需要的去甲肾上腺素（1.31mg±0.83mg）少于 10-SAAP（0.76mg±0.24mg），P=0.008。
即使在出血引起的无支持性心脏骤停 10 分钟后，全血 SAAP 仍可实现高 ROSC 率，且在 15 分钟后仍具有一定的活力。这是一种有前途的 ECA 工具，但需要进一步优化和临床试验。动物使用协议，IACUC：0919015。
