Gurevich Sergey, Kalra Rajat, Kosmopoulos Marinos, Marquez Alexandra M, Jaeger Deborah, Bemenderfer Mitchell, Burroughs Danielle, Bartos Jason A, Yannopoulos Demetris, Voicu Sebastian
Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States.
Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN 55401, United States.
Resusc Plus. 2024 Nov 9;20:100826. doi: 10.1016/j.resplu.2024.100826. eCollection 2024 Dec.
Extracorporeal life support (ECLS) provides organ perfusion in refractory cardiac arrest but during the initiation of ECLS mean arterial pressure (MAP) and carotid flow may be suboptimal due to hypotension and/or insufficient flow. We hypothesized that cardiopulmonary resuscitation (CPR) in addition to ECLS may increase carotid flow and MAP compared to ECLS alone.
Observational pilot study comparing hemodynamic parameters before and after CPR cessation in pigs supported by ECLS for experimental refractory cardiac arrest. Pigs were anesthetized, ventricular fibrillation was induced for 3 min, automated CPR performed for 30 min, ECLS was initiated then CPR stopped.Variables averaged over 3 s were compared between the last 3 s of CPR + ECLS and 3, 6, 30 s, and 5 and 10 min of ECLS alone. Data are expressed as medians (25-75 interquartile range) and compared using paired samples Wilcoxon test.
Nine pigs were included, ECLS was initiated at 2.7 (2.3-2.8) L/min. MAP during CPR + ECLS was 56(53.0-59.2) mmHg, 50(45-57)mmHg, 52(46-59)mmHg, 61(50-63)mmHg, 57 (54-66)mmHg, 54 (47-58)mmHg of ECLS alone, p = 0.50, 0.61, 0.70, 0.44, 0.73 respectively. Carotid flow was 113(78-119) ml/min during CPR + ECLS 99(79-110)ml/min, 100(81-110)ml/min, 96(60-122)ml/min, 118 (101-130)ml/min, 124 (110-141)ml/min, p = 0.41, 0.52, 0.73, 0.33, 0.20 respectively. When ECLS was initiated at lower flow, 1.5 L/min (one pig), MAP decreased from 59 to 45 mmHg, and carotid flow from 78.2 to 32.5 ml/min after 3 s of ECLS alone.
Stopping CPR after effective ECLS initiation does not decrease MAP or carotid flow. Future studies may evaluate augmenting low flow ECLS with CPR.
体外生命支持（ECLS）为难治性心脏骤停提供器官灌注，但在启动ECLS期间，由于低血压和/或流量不足，平均动脉压（MAP）和颈动脉血流可能不理想。我们假设，与单独使用ECLS相比，除ECLS外进行心肺复苏（CPR）可能会增加颈动脉血流和MAP。
一项观察性试点研究，比较了接受ECLS支持的实验性难治性心脏骤停猪在CPR停止前后的血流动力学参数。猪被麻醉，诱发室颤3分钟，进行自动CPR 30分钟，然后启动ECLS并停止CPR。比较CPR + ECLS的最后3秒与单独ECLS的3秒、6秒、30秒以及5分钟和10分钟期间平均3秒的变量。数据以中位数（25 - 75四分位间距）表示，并使用配对样本Wilcoxon检验进行比较。
纳入9头猪，ECLS启动时流量为2.7（2.3 - 2.8）L/分钟。CPR + ECLS期间的MAP分别为56（53.0 - 59.2）mmHg，单独ECLS时分别为50（45 - 57）mmHg、52（46 - 59）mmHg、61（50 - 63）mmHg、57（54 - 66）mmHg、54（47 - 58）mmHg，p值分别为0.50、0.61、0.70、0.44、0.73。CPR + ECLS期间的颈动脉血流为113（78 - 119）ml/分钟，单独ECLS时分别为99（79 - 110）ml/分钟、100（81 - 110）ml/分钟、96（60 - 122）ml/分钟、118（101 - 130）ml/分钟、124（110 - 141）ml/分钟，p值分别为0.41、0.52、0.73、0.33、0.20。当以较低流量1.5 L/分钟启动ECLS时（1头猪），单独ECLS 3秒后，MAP从59降至45 mmHg，颈动脉血流从78.2降至32.5 ml/分钟。
在有效启动ECLS后停止CPR不会降低MAP或颈动脉血流。未来的研究可评估用CPR增强低流量ECLS。
