Successful ECMO-cardiopulmonary resuscitation with the associated post-arrest cardiac dysfunction as demonstrated by MRIReportar como inadecuado




Successful ECMO-cardiopulmonary resuscitation with the associated post-arrest cardiac dysfunction as demonstrated by MRI - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Intensive Care Medicine Experimental

, 3:25

First Online: 03 September 2015Received: 27 March 2015Accepted: 18 August 2015

Abstract

BackgroundVeno-arterial extracorporeal membrane oxygenation ECMO-CPR is a life-saving rescue for selected patients when standard cardiopulmonary resuscitation fails. The use is increasing although the treatment modality is not fully established. Resuscitated patients typically develop a detrimental early post-arrest cardiac dysfunction that also deserves main emphasis. The present study investigates an ECMO-CPR strategy in pigs and assesses early post-arrest left ventricular function in detail. We hypothesised that a significant dysfunction could be demonstrated with this model using magnetic resonance imaging MRI, not previously used early post-arrest.

MethodsIn eight anaesthetised pigs, a 15-min ventricular fibrillation was resuscitated by an ECMO-CPR strategy of 150-min veno-arterial ECMO aiming at high blood flow rate and pharmacologically sustained aortic blood pressure and pulse pressure of 50 and 15 mmHg, respectively. Pre-arrest cardiac MRI and haemodynamic measurements of left ventricular function were compared to measurements performed 300-min post-arrest.

ResultsAll animals were successfully resuscitated, weaned from the ECMO circuit, and haemodynamically stabilised post-arrest. Cardiac output was maintained by an increased heart rate post-arrest, but left ventricular ejection fraction and stroke volume were decreased by approximately 50 %. Systolic circumferential strain and mitral annular plane systolic excursion as well as the left ventricular wall thickening were reduced by approximately 50–70 % post-arrest. The diastolic function variables measured were unchanged.

ConclusionsThe present animal study demonstrates a successful ECMO-CPR strategy resuscitating long-lasting cardiac arrest with adequate post-arrest haemodynamic stability. The associated severe systolic left ventricular dysfunction could be charted in detail by MRI, a valuable tool for future cardiac outcome assessments in resuscitation research.

Trial registrationInstitutional protocol number: FOTS 4611-13.

KeywordsECMO-cardiopulmonary resuscitation ECMO Post-arrest Left ventricular function Cardiac MRI Haemodynamics AbbreviationsHRheart rate

COphase and SVphasecardiac output and stroke volume by cardiac MRI phase-contrast technique

EDVend-diastolic volume

ESVend-systolic volume

Wall thickening septum and Wall thickening latmid left ventricular radial wall thickening in septum and lateral wall

MAPSEantsept and MAPSEpostlatmitral annular plane systolic excursion measured anteroseptally and posterolaterally

HRPA, COPA and SVPApulmonary artery catheter assessments of heart rate, cardiac output and stroke volume

MAPmean aortic pressure

CVPcentral venous pressure

Wedgepulmonary arterial wedge pressure

SVRsystemic vascular resistance

LVPmaxsystolic left ventricular pressure maximum

EDPend diastolic pressure

dP-dtmax and dP-dtminmaximum and minimum LVP time derivates

tautsovolumetric relaxation constant

Eaarterial elastance

DDdiastolic duration

SDsystolic duration

IVCisovolumetric contraction time

SVO2mixed venous oxygen saturation

DO2oxygen delivery

VO2oxygen consumption

Electronic supplementary materialThe online version of this article doi:10.1186-s40635-015-0061-2 contains supplementary material, which is available to authorized users.

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Autor: Harald Arne Bergan - Per Steinar Halvorsen - Helge Skulstad - Thor Edvardsen - Erik Fosse - Jan Frederik Bugge

Fuente: https://link.springer.com/



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