Abstract
Extracorporeal membrane cardiopulmonary resuscitation (ECPR) during cardiopulmonary resuscitation (CPR) for selected cases and end-tidal carbon dioxide (ETCO2) could be used to guide initiation of ECPR. Ventricular fibrillation was induced in 12 pigs and CPR was performed until ETCO2 fell below 10 mmHg; then, ECPR was performed. Animals were divided into group short (GShort) and group long (GLong), according to time of CPR. Carotid blood flow was higher (p = 0.02) and mean arterial blood pressure lower in GLong during CPR (p < 0.05). B-Lactate was lower and pH higher in GShort (p < 0.01). In microdialysis lactate-pyruvate ratio, glycerol and glutamate increased in both groups during CPR, but considerably in GLong (p < 0.01). No difference could be seen in histopathology of the brain or kidney post-ECPR. No apparent histological differences of tissue damage in brains or levels of S100B in plasma were detected between groups. This might suggest that ETCO2 could be used as a marker for brain injury following ECPR.Graphical abstract
Highlights
extracorporeal cardiopulmonary resuscitation (ECPR) treatment is rapidly increasing in numbers
The difference in lactate/pyruvate ratio returned to normal after the episode of ECPR (Fig. 3), and no other differences were detected in the parameters of microdialysis at end of ECPR (Table 2). This experimental model of conventional cardiopulmonary resuscitation (CPR) followed by ECPR used ETCO2 as the determinant of when to start ECPR
The main finding is that when levels of ETCO2 are used to initiate ECPR, there were some subtle biochemical differences, but the extent of kidney and brain injury in histopathology was comparable between the groups at end of ECPR, regardless of the time of CPR
Summary
Cardiac arrest still carries a high mortality rate with survival to discharge only 10–15% in witnessed arrests [1, 2] and close to 0% if unwitnessed [3]. The introduction of extracorporeal cardiopulmonary resuscitation (ECPR) has increased survival in witnessed arrests [4–6], but neurologic and renal complications remain high [7]. ECPR treatment is rapidly increasing in numbers. The treatment is expensive, resource-demanding, and associated with severe complications and its usage must be optimised. Existing selection criteria which predict a favourable patient outcome, based on retrospective studies, have identified shockable rhythm, shorter low-flow time, higher pH, and lower B-lactate [8–10]. In spite of some progress made in identification of favourable predictors, mortality and morbidity after ECPR are still unacceptably high
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