Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged XXXX : a large animal study.

@entity1164 @entity1707 @entity296 @entity63 @entity2224 @entity1167 @entity204
INTRODUCTION: Despite improvements in pre-hospital and post-arrest critical care, @entity1164 ( @entity1167 ) remains one of the leading causes of @entity204 . Improving circulation during cardiopulmonary resuscitation (CPR) may improve survival rates and long-term clinical outcomes after @entity1167 . METHODS: In a porcine model, we compared standard CPR (sCPR; n =10) with CPR using an intravascular cardiac assist device without additional chest compressions (iCPR; n =10) following 10  minutes of electrically induced @entity2224 ( @entity2224 ). In a separate crossover experiment, 10 additional @entity1707 were subjected to 10  minutes of @entity2224 and 6  minutes of sCPR; the iCPR device was then implanted if a return of spontaneous circulation (ROSC) was not achieved using sCPR. Animals were evaluated in respect to intra- and post-arrest hemodynamics, survival, functional outcome and cerebral and @entity296 following CPR. We hypothesized that iCPR would result in more frequent ROSC and better functional recovery than sCPR. RESULTS: iCPR produced a mean flow of 1.36        0.02  L/min, leading to significantly higher coronary perfusion pressure (CPP) values during the early period of CPR (22        10  mmHg vs. 9        5  mmHg, P  <=0.01, 1  minute after start of CPR; 20        11  mmHg vs. 10        7  mmHg, P =0.03, 2  minutes after start of CPR), resulting in high ROSC rates (100% in iCPR vs. 50% in sCPR animals; P =0.03). iCPR animals showed significantly lower serum S100 levels at 10 and 30  minutes following ROSC (3.5        0.6  ng/ml vs. 7.4        3.0  ng/ml 30  minutes after ROSC; P  <=0.01), as well as superior clinical outcomes based on overall performance categories (2.9        1.0 vs. 4.6        0.8 on day 1; P  <=0.01). In crossover experiments, 80% of animals required treatment with iCPR after failed sCPR. Notably, ROSC was still achieved in six of the remaining eight animals (75%) after a total of 22.8        5.1  minutes of @entity63 . CONCLUSIONS: In a model of prolonged @entity1167 , the use of iCPR instead of sCPR improved CPP and doubled ROSC rates, translating into improved clinical outcomes.
