Effect of percutaneous ventricular assisted device on post-cardiac arrest myocardial dysfunction in swine model with prolonged cardiac arrest

• Published in: Resuscitation Vol. 193; p. 110010
• Main Authors: Nakashima, Takahiro, Hakam Tiba, Mohamad, McCracken, Brendan M, Hsu, Cindy H, Gottula, Adam L, Greer, Nicholas L, Cramer, Traci A, Sutton, Nadia R, Ward, Kevin R, Neumar, Robert W
• Format: Journal Article
• Language: English
• Published: Ireland 01-12-2023
• Subjects: Animals; Cardiopulmonary Resuscitation - methods; Disease Models, Animal; Heart Arrest - complications; Heart-Assist Devices; Perfusion - adverse effects; Stroke Volume; Swine; Ventricular Fibrillation - complications; Ventricular Function, Left; Aortic balloon occlusion; Percutaneous ventricular assisted device; Cardiac arrest; Prolonged cardiac arrest
• ISSN: 0300-9572; 1873-1570; 1873-1570
• DOI: 10.1016/j.resuscitation.2023.110010

It remains unclear if percutaneous left ventricular assist device (pLVAD) reduces post-cardiac arrest myocardial dysfunction.
This is a prespecified analysis of a subset of swine that achieved return of spontaneous circulation (ROSC) in a study comparing pLVAD, transient aortic occlusion (AO), or both during cardiopulmonary resuscitation (CPR). Devices were initiated after 24 minutes of ventricular fibrillation cardiac arrest (8 min no-flow and 16 min mechanical CPR). AO was discontinued post-ROSC, and pLVAD support or standard care were continued. Beginning 60 minutes post-ROSC, pLVAD support was weaned to < 1.0 L/min and subsequently removed at 240 minutes. The primary outcome was cardiac index (CI), stroke volume index (SVI), and left ventricular ejection fraction (LVEF) at 240 minutes post-ROSC. Data are shown as mean (standard error).
Seventeen swine achieved ROSC without complication and were included in this analysis (pLVAD group, n = 11 and standard care group, n = 6). For the primary outcomes, the pLVAD group had significantly higher CI of 4.2(0.3) vs. 3.1(0.4) L/min/m
(p = 0.043) and LVEF 60(3) vs. 49(4) % (p = 0.029) at 240 minutes after ROSC when compared with the standard care group, while SVI was not statistically significantly different (32[3] vs. 23[4] mL/min/m
, p = 0.054). During the first 60 minutes post-ROSC, the pLVAD group had significantly higher coronary perfusion pressure, lower LV stroke work index, and total pulmonary resistance index.
These results suggest that early pLVAD support after ROSC is associated with better recovery myocardial function compared to standard care after prolonged cardiac arrest.