Louise Linde

Extracorporeal Cardio Pulmonary Resuscitation - from translational science to clinical practice

Background

The survival of patients with cardiac arrest outside the hospital is closely linked to the provision of quick and effective first-aid rescue. Not infrequently, the patient’s own circulation cannot be restored despite resuscitation with CPR and attempts to restart the heart with a cardiac defibrillator. In selected patients with persistent cardiac arrest, the patient can be taken to the hospital with ongoing cardiac massage to attempt to establish mechanical circulatory support, so-called eCPR treatment. The treatment is very extensive for the patient, relatives, and the hospital system and there is little knowledge about optimal treatment algorithms as well as which mechanical circulatory support system provides optimal support for both brain and heart.

Purpose

The purpose of Study 1 is to evaluate the experience of eCPR in the Region of Southern Denmark over a 5-year period from November 2015-2020, with a focus on examining the reasons for terminating treatment upon arrival at the hospital. In addition, we examine what characterizes the patients in whom eCPR is initiated and how the patient copes with resuscitation (discharge at home, disability or death as well as complications during treatment), depending on the type of mechanical circulatory support system used. The purpose of Study 2 is to investigate whether the combination of two mechanical circulatory support systems is better for both the heart and the brain than only the use of one mechanical circulatory support system.

Method

Study 1 is a retrospective study with a review of electronic patient records of patients received for possible eCPR treatment. A total of 125 patient courses are expected to form the basis of the study. Study 2 is an experimental animal study on 24 female pigs. The pig is under anesthesia when arriving and is given cardiac arrest. The animal will undergo CPR for 15 min. until mechanical circulatory support is established. 12 pigs will receive one mechanical circulatory support system, a sort of heart-lung machine, and 12 pigs will receive two types of mechanical circulatory support, both the heart-lung machine and another pump called Impella. The pigs will remain on the machines for 4 hours. Towards the study period parameters of brain and heart function will be assessed. The pigs will be euthanatized at the end of the study.

To our knowledge, no previous studies have examined reasons to terminate treatment upon arrival at the hospital. The same goes for the use of two types of mechanical circulatory support in a pig model of cardiac arrest. The eCPR treatment is still quite new and it is important to evaluate the treatment and hopefully optimize the treatment for long time cardiac arrest.