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| Successful Resuscitation After Prolonged Periods of Cardiac Arrest - A New Field in Cardiac Surgery | |
Georg Trummer1, Katharina Foerster1, Gerald D. Buckberg2, Christoph Benk1, Claudia Heilmann1, Irina Mader1, Friedrich Feuerhake1, Oliver Liakopoulos2, Kerstin Brehm1, Friedhelm Beyersdorf1; 1University Hospital Freiburg, Freiburg, Germany; 2David Geffen School of Medicine, University of California, Los Angeles, CA
We assessed the hypothesis that whole-body controlled reperfusion using peripheral extracorporal circulation will limit reperfusion injury after 15 mins of normothermic CA with improved survival and neurologic recovery. Methods: Eleven pigs (54.9±4.5 Kg BW) were anesthesized and ventilated. Animals were exposed to normothermic ischemia for 15 mins after induction of ventricular fibrillation (VF). Thereafter, either conventional CPR-ALS (control group, n=4) or peripheral extracorporal circulation (ECC) was started (experimental group, n=7). In the ECC-group, conditions of reperfusion were controlled regarding pressure, flow and the composition of the reperfusate. ECC was stopped after 60 mins and the animals were allowed to regain consciousness. Neurologic assessment followed a scoring system (Neurologic Deficit Score (NDS): 0=normal; 500= brain death) while MRI and brain histology were performed at the end of the experiment (day 7). Results: In the experimental group all (n=7) animals survived. 6/7 had 100% neurological recovery within 48 hours until day 7 (NDS=0 +/- 0), 1 fully conscious pig was not able to walk. This animal showed an incomplete recovery (NDS=145) and had to be sacrificed after 30 hours. All animals (n=7) regained full cardiac, kidney, liver and lung recovery, and only mild changes in ischemia-sensitive brain-areas were revealed by MRI and brain histology. All animals in the control group (n=4) died within 20 min despite continuous CPR-ALS. Conclusion: This study demonstrates for the first time complete functional neurologic recovery after a period of 15 mins CA. This is in contrast to currently used conventional treatment methods, where successful resuscitation has been reported only after 3-5 mins of CA. This new surgical technique to limit ischemia-reperfusion injury of the whole body including the brain by controlling the conditions of reperfusion using ECC is a new approach toward survival and functional recovery of patients undergoing sudden death. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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