Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs
BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) is widely proposed for the treatment of refractory cardiac arrest. It should be associated with coronary angiography if coronary artery disease is suspected. However, the prioritization of care remains unclear in this situation. Our goal...
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| Format: | Article |
| Language: | English |
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Wiley
2016-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.004588 |
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| author | Alice Hutin Lionel Lamhaut Fanny Lidouren Matthias Kohlhauer Nicolas Mongardon Pierre Carli Alain Berdeaux Bijan Ghaleh Renaud Tissier |
| author_facet | Alice Hutin Lionel Lamhaut Fanny Lidouren Matthias Kohlhauer Nicolas Mongardon Pierre Carli Alain Berdeaux Bijan Ghaleh Renaud Tissier |
| author_sort | Alice Hutin |
| collection | DOAJ |
| description | BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) is widely proposed for the treatment of refractory cardiac arrest. It should be associated with coronary angiography if coronary artery disease is suspected. However, the prioritization of care remains unclear in this situation. Our goal was to determine whether coronary reperfusion should be instituted as soon as possible in such situations in a pig model. Methods and ResultsAnesthetized pigs were instrumented and submitted to coronary artery occlusion and ventricular fibrillation. After 5 minutes of untreated cardiac arrest, conventional cardiopulmonary resuscitation (CPR) was started. Fifteen minutes later, ECPR was initiated for a total duration of 240 minutes. Animals randomly underwent either early or late coronary reperfusion at 20 or 120 minutes of ECPR, respectively. This timing was adapted to the kinetic of infarct extension in pigs. Return of spontaneous circulation was determined as organized electrocardiogram rhythm with systolic arterial pressure above 80 mm Hg. During conventional CPR, hemodynamic parameters were not different between groups. Carotid blood flow then increased by 70% after the onset of ECPR in both groups. No animal (0 of 7) elicited return of spontaneous circulation after late reperfusion versus 4 of 7 after early reperfusion (P=0.025). The hemodynamic parameters, such as carotid blood flow, were also improved in early versus late reperfusion groups (113±20 vs 43±17 mL/min after 240 minutes of ECPR, respectively; P=0.030), along with infarct size decrease (71±4% vs 84±2% of the risk zone, respectively; P=0.013). ConclusionsEarly reperfusion improved hemodynamic status and facilitated return of spontaneous circulation in a porcine model of ischemic cardiac arrest treated by ECPR. |
| first_indexed | 2024-12-23T04:54:01Z |
| format | Article |
| id | doaj.art-85052a45c1f14ded967f3d771ba1d364 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-23T04:54:01Z |
| publishDate | 2016-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-85052a45c1f14ded967f3d771ba1d3642022-12-21T17:59:23ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-12-0151210.1161/JAHA.116.004588Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in PigsAlice Hutin0Lionel Lamhaut1Fanny Lidouren2Matthias Kohlhauer3Nicolas Mongardon4Pierre Carli5Alain Berdeaux6Bijan Ghaleh7Renaud Tissier8Inserm, U955, Equipe 03, Créteil, FranceDépartement d'Anesthésie Réanimation, Hôpital Universitaire Necker‐Enfants Malades, SAMU de Paris, Université Paris Descartes–Paris V, Paris, FranceInserm, U955, Equipe 03, Créteil, FranceInserm, U955, Equipe 03, Créteil, FranceInserm, U955, Equipe 03, Créteil, FranceDépartement d'Anesthésie Réanimation, Hôpital Universitaire Necker‐Enfants Malades, SAMU de Paris, Université Paris Descartes–Paris V, Paris, FranceInserm, U955, Equipe 03, Créteil, FranceInserm, U955, Equipe 03, Créteil, FranceInserm, U955, Equipe 03, Créteil, FranceBackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) is widely proposed for the treatment of refractory cardiac arrest. It should be associated with coronary angiography if coronary artery disease is suspected. However, the prioritization of care remains unclear in this situation. Our goal was to determine whether coronary reperfusion should be instituted as soon as possible in such situations in a pig model. Methods and ResultsAnesthetized pigs were instrumented and submitted to coronary artery occlusion and ventricular fibrillation. After 5 minutes of untreated cardiac arrest, conventional cardiopulmonary resuscitation (CPR) was started. Fifteen minutes later, ECPR was initiated for a total duration of 240 minutes. Animals randomly underwent either early or late coronary reperfusion at 20 or 120 minutes of ECPR, respectively. This timing was adapted to the kinetic of infarct extension in pigs. Return of spontaneous circulation was determined as organized electrocardiogram rhythm with systolic arterial pressure above 80 mm Hg. During conventional CPR, hemodynamic parameters were not different between groups. Carotid blood flow then increased by 70% after the onset of ECPR in both groups. No animal (0 of 7) elicited return of spontaneous circulation after late reperfusion versus 4 of 7 after early reperfusion (P=0.025). The hemodynamic parameters, such as carotid blood flow, were also improved in early versus late reperfusion groups (113±20 vs 43±17 mL/min after 240 minutes of ECPR, respectively; P=0.030), along with infarct size decrease (71±4% vs 84±2% of the risk zone, respectively; P=0.013). ConclusionsEarly reperfusion improved hemodynamic status and facilitated return of spontaneous circulation in a porcine model of ischemic cardiac arrest treated by ECPR.https://www.ahajournals.org/doi/10.1161/JAHA.116.004588cardiac arrestcardiopulmonary resuscitationECMOmyocardial infarctionreperfusion |
| spellingShingle | Alice Hutin Lionel Lamhaut Fanny Lidouren Matthias Kohlhauer Nicolas Mongardon Pierre Carli Alain Berdeaux Bijan Ghaleh Renaud Tissier Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac arrest cardiopulmonary resuscitation ECMO myocardial infarction reperfusion |
| title | Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs |
| title_full | Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs |
| title_fullStr | Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs |
| title_full_unstemmed | Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs |
| title_short | Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs |
| title_sort | early coronary reperfusion facilitates return of spontaneous circulation and improves cardiovascular outcomes after ischemic cardiac arrest and extracorporeal resuscitation in pigs |
| topic | cardiac arrest cardiopulmonary resuscitation ECMO myocardial infarction reperfusion |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.004588 |
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