Advertisement

Moving toward mechanical control of cardiac arrest

      Use of mechanical circulatory support in the management of cardiac arrest has generated considerable discussion in recent years. Much of this discussion has revolved around extracorporeal membrane oxygenation (ECMO).
      • SAVE-J Study Group
      • Sakamoto T.
      • Morimura N.
      • et al.
      Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study.
      • Bellezzo J.
      • Shinar Z.
      • Davis D.
      Emergency physician-initiated extracorporeal cardiopulmonary resuscitation.
      In this issue of Resuscitation, Vase et al. introduce the Impella® device as a novel technology for restoration of spontaneous circulation (ROSC).
      • Vase H.
      • Christensen S.
      • Christiansen A.
      • et al.
      The Impella CP® device for acute mechanical circulatory support in refractory cardiac arrest.
      The percutaneous Impella CP® was used to augment blood flow in the left ventricle during cardiac arrest. Impella®, in contrast to venoarterial (VA) ECMO, may create a more physiologic type of support by propelling blood antegrade from the left heart through the aorta. In cardiogenic shock, studies have supported the use of Impella®,
      • Schiller P.
      • Vikholm P.
      • Hellgren L.
      The Impella® Recover mechanical assist device in acute cardiogenic shock: a single-centre experience of 66 patients.
      • Pappalardo F.
      • Schulte C.
      • Pieri M.
      Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock.
      • Lauten A.
      • Engstrom A.E.
      • Jung C.
      • et al.
      Percutaneous left ventricular support with the Impella® 2.5 assist device in acute cardiogenic shock—results of the Impella® EUROSHOCK-registry.
      • Lemaire A.
      • Anderson M.B.
      • Lee L.Y.
      • et al.
      The Impella® device for acute mechanical circulatory support in patients in cardiogenic shock.
      • Cheng J.M.
      • den Uil C.A.
      • Hoeks S.E.
      • et al.
      Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials.
      but in cardiac arrest, the data has been limited to porcine models.
      • Tuseth V.
      • Pettersen R.J.
      • Grong K.
      • et al.
      Randomised comparison of percutaneous left ventricular assist device with open-chest cardiac massage and with surgical assist device during ischaemic cardiac arrest.
      • Derwall M.
      • Brücken A.
      • Bleilevens C.
      • et al.
      Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study.
      This human case series challenges us to assess whether Impella® is efficacious, safe even feasible for cardiac arrest resuscitation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Schiller P.
        • Vikholm P.
        • Hellgren L.
        The Impella® Recover mechanical assist device in acute cardiogenic shock: a single-centre experience of 66 patients.
        Interact Cardiovasc Thorac Surg. 2016; 22: 452-458https://doi.org/10.1093/icvts/ivv305
        • Pappalardo F.
        • Schulte C.
        • Pieri M.
        Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock.
        Eur J Heart Fail. 2016; https://doi.org/10.1002/ejhf.668
        • Lauten A.
        • Engstrom A.E.
        • Jung C.
        • et al.
        Percutaneous left ventricular support with the Impella® 2.5 assist device in acute cardiogenic shock—results of the Impella® EUROSHOCK-registry.
        Circ Heart Fail. 2013; 6: 23-30
        • Lemaire A.
        • Anderson M.B.
        • Lee L.Y.
        • et al.
        The Impella® device for acute mechanical circulatory support in patients in cardiogenic shock.
        Ann Thorac Surg. 2014; 97: 133-138
        • Cheng J.M.
        • den Uil C.A.
        • Hoeks S.E.
        • et al.
        Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials.
        Eur Heart J. 2009; 30: 2102-2108https://doi.org/10.1093/eurheartj/ehp292
        • Tuseth V.
        • Pettersen R.J.
        • Grong K.
        • et al.
        Randomised comparison of percutaneous left ventricular assist device with open-chest cardiac massage and with surgical assist device during ischaemic cardiac arrest.
        Resuscitation. 2010; 81: 1566-1570https://doi.org/10.1016/j.resuscitation.2010.06.008
        • Wang C.-H.
        • Chou N.-K.
        • Becker L.B.
        • et al.
        Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest—a comparison with that for extracorporeal rescue for in-hospital cardiac arrest.
        Resuscitation. 2014; 85: 1219-1224https://doi.org/10.1016/j.resuscitation.2014.06.022
        • Stub D.
        • Bernard S.
        • Pellegrino V.
        • et al.
        Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial).
        Resuscitation. 2015; 86: 88-94https://doi.org/10.1016/j.resuscitation.2014.09.010
        • Stottrup N.B.
        • Jakobsen L.
        • Krusell L.R.
        • Terkelsen C.J.
        Utility of Impella® left ventricular assist device during cardiac arrest: a case report.
        Int J Cardiol. 2016; 225: 111-112https://doi.org/10.1016/j.ijcard.2016.09.074
        • Kizner L.
        • Flottmann C.
        • Horstkotte D.
        • Gummert J.
        Bilateral antegrade perfusion of the superficial femoral artery to prevent limb ischemia during combined use of Impella CP® left ventricular assist device and extracorporeal life support.
        Interact Cardiovasc Thorac Surg. 2016; 23: 335-337https://doi.org/10.1093/icvts/ivw115
        • Derwall M.
        • Brücken A.
        • Bleilevens C.
        • et al.
        Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study.
        Crit Care. 2015; 19: 123https://doi.org/10.1186/s13054-015-0864-2
        • SAVE-J Study Group
        • Sakamoto T.
        • Morimura N.
        • et al.
        Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study.
        Resuscitation. 2014; 85: 762-768https://doi.org/10.1016/j.resuscitation.2014.01.031
        • Bellezzo J.
        • Shinar Z.
        • Davis D.
        Emergency physician-initiated extracorporeal cardiopulmonary resuscitation.
        Resuscitation. 2012; 83: 966-970https://doi.org/10.1016/j.resuscitation.2012.01.027
        • Shinar Z.
        • Bellezzo J.
        • Stahovich M.
        Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs).
        Resuscitation. 2014; 85: 702-704https://doi.org/10.1016/j.resuscitation.2014.01.003
        • Vase H.
        • Christensen S.
        • Christiansen A.
        • et al.
        The Impella CP® device for acute mechanical circulatory support in refractory cardiac arrest.
        Resuscitation. 2017; 112: 70-74