13 - Selective Aortic Arch Perfusion

Abstract

Selective aortic arch perfusion (SAAP) is an endovascular extracorporeal perfusion technique specifically designed for cardiac arrest resuscitation. SAAP is applicable to both medical and traumatic cardiac arrest. SAAP involves the insertion of a large-lumen balloon occlusion catheter into the thoracic aorta via a femoral artery. With the balloon inflated, the aortic arch vessels, including the coronary, carotid, and vertebral arteries, have been relatively isolated for perfusion with an oxygen-carrying perfusate infused through the central large-lumen of the catheter. The primary objective of SAAP resuscitation is to provide temporary heart and brain perfusion support until return of spontaneous circulation (ROSC), defined as recovery of intrinsic cardiac contractility with a viable arterial blood pressure, while protecting the ischemic brain. A series of SAAP modalities, including the use of an exogenous oxygen carrier followed by autologous blood, allows for extracorporeal perfusion support until ROSC and, if needed, bridging perfusion support until cannulation for sustained venoarterial extracorporeal life support (VA-ECLS) to the entire body. SAAP has been studied in laboratory models of both hemorrhage-induced traumatic cardiac arrest (HiTCA) and ventricular fibrillation (VF) medical cardiac arrest with highly favorable results. In HiTCA, SAAP provides for rapid replacement of lost intravascular volume and arterial hemorrhage control caudal to the inflated thoracic aortic balloon, in addition to promoting ROSC. SAAP is an aortic balloon–catheter extracorporeal perfusion therapy that fits in the endovascular resuscitation spectrum between basic CPR/advanced cardiac life support and REBOA on one side and sustained VA-ECLS and resuscitative thoracotomy on the other.