Document Detail

Percutaneous left ventricular assist in ischemic cardiac arrest.
MedLine Citation:
PMID:  19242324     Owner:  NLM     Status:  MEDLINE    
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 L x min(-1) x m2 (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.
Vegard Tuseth; Mohamed Salem; Reidar Pettersen; Ketil Grong; Svein Rotevatn; Tore Wentzel-Larsen; Jan Erik Nordrehaug
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  37     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-25     Completed Date:  2009-05-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1365-72     Citation Subset:  AIM; IM    
Department of Heart Disease, Haukeland University Hospital, N-5021 Bergen, Norway.
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MeSH Terms
Heart Arrest / etiology*,  physiopathology,  surgery*
Heart-Assist Devices*
Myocardial Ischemia / complications*,  physiopathology

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