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Pulsatile venous-arterial perfusion using a novel synchronized cardiac assist device augments coronary artery blood flow during ventricular fibrillation

Session Poster session 6

Speaker Ulrich Laufs

Event : ESC Congress 2014

  • Topic : imaging
  • Sub-topic : Echocardiography: Systolic and Diastolic Function
  • Session type : Poster Session

Authors : B Cremers (Homburg,DE), A Link (Homburg,DE), C Werner (Homburg,DE), H Gorhan (Heilbronn,DE), I Simundic (Heilbronn,DE), G Matheis (Heilbronn,DE), B Scheller (Homburg,DE), M Boehm (Homburg,DE), U Laufs (Homburg,DE)

Authors:
B. Cremers1 , A. Link1 , C. Werner1 , H. Gorhan2 , I. Simundic2 , G. Matheis2 , B. Scheller1 , M. Boehm1 , U. Laufs1 , 1Universitätsklinikum des Saarlandes - Klinik für Innere Medizin III - Homburg - Germany , 2Novalung GmbH - Heilbronn - Germany ,

Citation:
European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 1003

Patients with cardiogenic shock have a very high mortality. Here we report the first use of a percutaneous pulsatile cardiac assist device based on a novel control of a diagonal pump synchronized with the heart cycle by means of an ECG signal.

Eight domestic pigs underwent mandatory ventilation. During sinus rhythm, there were no differences between pulsatile and non-pulsatile perfusion with regard to pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), central venous pressure (CVP), MAP (mean arterial pressure), mean pulse pressure and mean coronary artery flow (CAF). After 2 minutes of complete cardiac arrest (ventricular fibrillation), circulatory support with the i-cor® in venoarterial non-pulsatile ECMO mode (3l/min) restored systemic circulation with an increase of MAP to 78.3mmHg and CAF to 5.27ml/min. After changing from ECMO settings to pulsatile mode (3l/min, 75 bpm, pulse amplitude range 3.500rpm), MAP did not change significantly (75.6mmHg), however CAF increased to 8.45ml/min. After changing back to non-pulsatile mode, MAP remained stable (83.6mmHg) but CAF decreased to 4.85ml/min. Thereafter pulsatile cardiac assist was established with a reduced blood flow of 2.5l/min and the pulse amplitude range was extended to 4.500 rpm. Under these conditions, MAP remained stable (71.0mmHg) but CAF significantly increased to 15.2ml/min, p<0.05.

Conclusion: Percutaneous cardiac support using a VA cardiac assist equipped with a novel diagonal pump is able to restore and increase systemic and coronary circulation during ventricular fibrillation. ECG triggered synchronized cardiac assist provides an additional increase of coronary artery flow. These promising results are to be confirmed in humans.

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