Background: Ischemic cardiac arrest represents a challenge
for optimal emergency revascularization therapy. A percutaneous
left ventricular assist device (LVAD) may be beneficial.
Objective: To determine the effect of a percutaneous LVAD
during cardiac arrest without chest compressions and to assess
the effect of fluid loading.
Design: Totally, 16 pigs randomized to either conventional or
intensive fluid with LVAD support during ventricular fibrillation (VF).
Setting: Acute experimental trial with pigs under general anesthesia.
Subjects: Farm pigs of both sexes.
Interventions: After randomization for fluid infusion, VF was
induced by balloon occlusion of the proximal left anterior descending
artery. LVAD and fluid were started after VF had been
induced.
Measurements: Brain, kidney, myocardial tissue perfusion,
and cardiac index were measured with the microsphere injection
technique at baseline, 3, and 15 minutes. Additional hemodynamic
monitoring continued until 30 minutes.
Main results: At 15 minutes, vital organ perfusion was maintained
without significant differences between the two groups.
Mean cardiac index at 3 minutes of VF was 1.2 Lmin1m2 (29%
of baseline, p < 0.05). Mean perfusion at 3 minutes was 65% in
the brain and 74% in the myocardium compared with baseline
(p < 0.05), then remained unchanged during the initial 15 minutes.
At 30 minutes, LVAD function was sustained in 11 of 16
animals (8 of 8 intensified fluid vs. 3 of 8 conventional fluid) and
was associated with intensified fluid loading (p < 0.001).
Conclusions: During VF, a percutaneous LVAD may sustain
vital organ perfusion. A potential clinical role of the device during
cardiac arrest has yet to be established. (Crit Care Med 2009; 37:
1365–1372)
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