Dataset Information

Mechanical Chest Compressions and Intra-Aortic Balloon Pump Combination for Refractory Ventricular Fibrillation During Primary PCI.

ABSTRACT: This case highlights the successful resuscitation of a 43-year-old man with ST-segment elevation myocardial infarction and refractory ventricular fibrillation by using a combination of mechanical chest compressions and intra-aortic balloon pump insertion. This bailout strategy facilitated primary multivessel percutaneous coronary intervention in a center without on-site extracorporeal membrane oxygenation. (Level of Difficulty: Advanced.).

SUBMITTER: Buckley AJ

PROVIDER: S-EPMC9040123 | biostudies-literature | 2022 Mar

REPOSITORIES: biostudies-literature

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Mechanical Chest Compressions and Intra-Aortic Balloon Pump Combination for Refractory Ventricular Fibrillation During Primary PCI.

Buckley Anthony J AJ O'Connor Cormac C Fitzgerald Sean S Hennessy Terence T Kiernan Thomas T

JACC. Case reports 20220316 6

This case highlights the successful resuscitation of a 43-year-old man with ST-segment elevation myocardial infarction and refractory ventricular fibrillation by using a combination of mechanical chest compressions and intra-aortic balloon pump insertion. This bailout strategy facilitated primary multivessel percutaneous coronary intervention in a center without on-site extracorporeal membrane oxygenation. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 35495556

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Project description:BackgroundQuantitative measures of the ventricular fibrillation (VF) ECG waveform can assess myocardial physiology and predict cardiac arrest outcomes, making these measures a candidate to help guide resuscitation. Chest compressions are typically paused for waveform measure calculation because compressions cause ECG artifact. However, such pauses contradict resuscitation guideline recommendations to minimize cardiopulmonary resuscitation interruptions. We evaluated a comprehensive group of VF measures with and without ongoing compressions to determine their performance under both conditions for predicting functionally-intact survival, the study's primary outcome.MethodsFive-second VF ECG segments were collected with and without chest compressions before 2755 defibrillation shocks from 1151 out-of-hospital cardiac arrest patients. Twenty-four individual measures and 3 combination measures were implemented. Measures were optimized to predict functionally-intact survival (Cerebral Performance Category score ≤2) using 460 training cases, and their performance evaluated using 691 independent test cases.ResultsMeasures predicted functionally-intact survival on test data with an area under the receiver operating characteristic curve ranging from 0.56 to 0.75 (median, 0.73) without chest compressions and from 0.53 to 0.75 (median, 0.69) with compressions ( P<0.001 for difference). Of all measures evaluated, the support vector machine model ranked highest both without chest compressions (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.73-0.78) and with compressions (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.72-0.78; P=0.75 for difference).ConclusionsVF waveform measures predict functionally-intact survival when calculated during chest compressions, but prognostic performance is generally reduced compared with compression-free analysis. However, support vector machine models exhibited similar performance with and without compressions while also achieving the highest area under the receiver operating characteristic curve. Such machine learning models may, therefore, offer means to guide resuscitation during uninterrupted cardiopulmonary resuscitation.

Project description:BackgroundRecent studies describe an emerging role for percutaneous left ventricular assist devices such as Impella CP® as rescue therapy for refractory cardiac arrest. We hypothesized that the addition of mechanical chest compressions to percutaneous left ventricular assist device assisted CPR would improve hemodynamics by compressing the right ventricle and augmenting pulmonary blood flow and left ventricular filling. We performed a pilot study to test this hypothesis using a swine model of prolonged cardiac arrest.MethodsEight Yorkshire swine were anesthetized, intubated, and instrumented for hemodynamic monitoring. They were subjected to untreated ventricular fibrillation for 5.75 (SD 2.90) minutes followed by mechanical chest compressions for a mean of 20.0 (SD 5.0) minutes before initiation of percutaneous left ventricular assist device. After percutaneous left ventricular assist device initiation, mechanical chest compressions was stopped (n = 4) or continued (n = 4). Defibrillation was attempted 4, 8 and 12 minutes after initiating percutaneous left ventricular assist device circulatory support.ResultsThe percutaneous left ventricular assist device + mechanical chest compressions group had significantly higher percutaneous left ventricular assist device flow prior to return of spontaneous heartbeat at four- and twelve-minutes after percutaneous left ventricular assist device initiation, and significantly higher end tidal CO2 at 4-minutes after percutaneous left ventricular assist device initiation, when compared with the percutaneous left ventricular assist device alone group. Carotid artery flow was not significantly different between the two groups.ConclusionThe addition of mechanical chest compressions to percutaneous left ventricular assist device support during cardiac arrest may generate higher percutaneous left ventricular assist device and carotid artery flow prior to return of spontaneous heartbeat compared to percutaneous left ventricular assist device alone. Further studies are needed to determine if this approach improves other hemodynamic parameters or outcomes after prolonged cardiac arrest.

Dataset Information

Mechanical Chest Compressions and Intra-Aortic Balloon Pump Combination for Refractory Ventricular Fibrillation During Primary PCI.

Publications

Mechanical Chest Compressions and Intra-Aortic Balloon Pump Combination for Refractory Ventricular Fibrillation During Primary PCI.

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