Randomised comparison of percutaneous left ventricular assist device with open-chest cardiac massage and with surgical assist device during ischaemic cardiac arrest☆☆☆

Abstract 

Aims

A percutaneous left ventricular assist device can maintain blood flow to vital organs during ventricular fibrillation and may improve outcomes in ischaemic cardiac arrest. We compared haemodynamic and clinical effects of a percutaneous left ventricular assist device with a larger device deployed via endovascular prosthesis and with open-chest cardiac massage during ischaemic cardiac arrest.

Methods

Eighteen swine were randomised into three groups. After thoracotomy, coronary ischaemia and ventricular fibrillation was induced. Cardiac output was measured with transit-time flowmetry. Tissue perfusion was measured with microspheres. Defibrillation was performed after 20min.

Results

Cardiac output with cardiac massage was 1129mLmin⁻¹ vs. 1169mLmin⁻¹ with the percutaneous- and 570mLmin⁻¹ with the surgical device (P<0.05 surgical vs. others). End-tidal CO₂ was 3.3kPa with cardiac massage vs. 3.2kPa with the percutaneous- and 2.3kPa with the surgical device (P<0.05 surgical vs. others). Subepicardial perfusion was 0.33mLmin⁻¹g⁻¹ with cardiac massage vs. 0.62mLmin⁻¹g⁻¹ with both devices (P<0.05 devices vs. massage), cerebral perfusion was comparable between groups (all reported values after 3min cardiac arrest, all P<0.05 vs. baseline, all P=NS for 3min vs. 15min). Return of spontaneous circulation was achieved in 5/6 subjects with cardiac massage vs. 6/6 with the percutaneous- and 4/6 with the surgical device (P=NS).

Conclusion

The percutaneous device improved myocardial perfusion, maintained cerebral perfusion and systemic circulation with similar rates of successful defibrillation vs. cardiac massage. Increased delivery was not obtained with the surgical device during cardiac arrest.

Keywords: Cardiac arrest, Percutaneous LVAD, Resuscitation, OCCM