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

Abstract

AbstractBackgroundPercutaneous left ventricular assist device (pLVAD) can provide hemodynamic support during and after cardiac arrest, but it remains unclear if pLVAD reduces post-cardiac arrest myocardial dysfunction.MethodsThis is an analysis of a subset of animals that achieved return of spontaneous circulation (ROSC) in a study comparing pLVAD, transient aortic occlusion (AO), or both during cardiopulmonary resuscitation (CPR) after prolonged cardiac arrest. pLVAD, AO, or both 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 while maintaining a mean arterial pressure >70 mmHg, and subsequently removed at 240 minutes when feasible. The primary outcome was the recovery of 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).ResultsSeventeen animals achieved ROSC without complication and were included in this analysis (pLVAD group, n = 11 and standard care group, n = 6). For the primary outcome, the pLVAD group had significantly higher CI of 4.2(0.3) vs. 3.1(0.4) L/min/m2 (p=0.043) and LVEF 60(3) vs. 49(4) % (p=0.029) at 240 minutes after ROSC, respectively, when compared with the standard care group, while SVI was not significant difference (2[3] vs. 23[4] mL/min/m2,p=0.054). During the first 60 minutes after ROSC with maximum pLVAD flow, the pLVAD group had significantly higher coronary perfusion pressure (62[4] vs. 47[5] mmHg, p=0.019), lower LV stroke work index (3.9[3.0] vs. 14.9[4.4] cJ/m2, p=0.043), and lower total pulmonary resistance index (13.2[4.8] vs. 21.5[14.4] Wood Unit, p=0.001).ConclusionThese results suggest that early pLVAD support after ROSC is associated with better recovery myocardial function compared to standard care after prolonged cardiac arrest.