Abstract 20812: Extracorporeal Membrane Oxygenation Sustains Survival in a Porcine Model of Prolonged Ventricular Fibrillation Cardiac Arrest

Introduction: Cardiac function worsens in the hours after resuscitation from prolonged cardiac arrest requiring use of pressors or inotropes which may further worsen the underlying injury. This study tested the hypothesis that this hemodynamic instability can be stabilized with percutaneously placed extracorporeal membrane oxygenation (ECMO) in a porcine model of prolonged cardiac arrest and resuscitation. This was hypothesized to decrease the need for inotropes and improve survival. Methods: Female pigs (n=12) were intubated and anesthetized. Ostial left anterior descending coronary artery occlusion was induced by endovascular balloon inflation. Induced VF was left untreated for 5 minutes followed by 10 minutes of CPR. The animals were randomized to standard ACLS (n=6) or ECMO (n=6). In the standard ACLS group, epinephrine 0.5 mg IV and defibrillation (200J) were delivered every 5 minutes until ROSC was achieved or 60 minutes of unsuccessful CPR had elapsed. In the ECMO group, epinephrine 0.5mg was delivered every 5 minutes without defibrillation until 30 minutes of CPR had elapsed at which time V-A ECMO was placed via femoral cannulation. In all animals, amiodarone and sodium bicarbonate were given with the first dose of epinephrine. The intra-coronary balloon was deflated after 30 minutes of CPR. Results: All animals treated with ECMO (6/6) survived to 4 hours compared to only 2/6 in the standard ACLS group. ECMO animals were more hemodynamically stable requiring less epinephrine. Blood pH normalized while lactic acid stabilized in the ECMO group compared to continued worsening in the standard ACLS group. Conclusion: ECMO improves survival to 4 hours in this porcine model of prolonged VF cardiac arrest providing improved hemodynamic stability and reduced inotrope requirements. ECMO may prevent injury induced by aggressive medical therapy during the first hours of ROSC.