Introduction: Despite improvements in pre-hospital and post-arrest critical care, sudden cardiac arrest (CA) remains\none of the leading causes of death. Improving circulation during cardiopulmonary resuscitation (CPR) may improve\nsurvival rates and long-term clinical outcomes after CA.\nMethods: In a porcine model, we compared standard CPR (sCPR; n =10) with CPR using an intravascular cardiac\nassist device without additional chest compressions (iCPR; n =10) following 10 minutes of electrically induced\nventricular fibrillation (VF). In a separate crossover experiment, 10 additional pigs were subjected to 10 minutes of\nVF and 6 minutes of sCPR; the iCPR device was then implanted if a return of spontaneous circulation (ROSC) was\nnot achieved using sCPR. Animals were evaluated in respect to intra- and post-arrest hemodynamics, survival, functional\noutcome and cerebral and myocardial lesions following CPR. We hypothesized that iCPR would result in more frequent\nROSC and better functional recovery than sCPR.\nResults: iCPR produced a mean flow of 1.36 �± 0.02 L/min, leading to significantly higher coronary perfusion\npressure (CPP) values during the early period of CPR (22 �± 10 mmHg vs. 9 �± 5 mmHg, P ?0.01, 1 minute after start of\nCPR; 20 �± 11 mmHg vs. 10 �± 7 mmHg, P =0.03, 2 minutes after start of CPR), resulting in high ROSC rates (100% in iCPR\nvs. 50% in sCPR animals; P =0.03). iCPR animals showed significantly lower serum S100 levels at 10 and 30 minutes\nfollowing ROSC (3.5 �± 0.6 ng/ml vs. 7.4 �± 3.0 ng/ml 30 minutes after ROSC; P ?0.01), as well as superior clinical outcomes\nbased on overall performance categories (2.9 �± 1.0 vs. 4.6 �± 0.8 on day 1; P ?0.01). In crossover experiments, 80% of\nanimals required treatment with iCPR after failed sCPR. Notably, ROSC was still achieved in six of the remaining eight\nanimals (75%) after a total of 22.8 �± 5.1 minutes of ischemia.\nConclusions: In a model of prolonged cardiac arrest, the use of iCPR instead of sCPR improved CPP and doubled ROSC\nrates, translating into improved clinical outcomes.
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