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Open chest selective aortic arch perfusion vs open cardiac massage as a means of perfusion during in exsanguination cardiac arrest: a comparison of coronary hemodynamics in swine

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Abstract

Aim

To describe and compare the aortic-right atrial pressure (AoP-RAP) gradients and mean coronary perfusion pressures (CPPs) generated during open chest selective aortic arch perfusion (OCSAAP) with those generated during open cardiac massage (OCM) in hypovolemic swine.

Methods

Ten male Hanford swine utilized in a prior poly-trauma study were included in the study. Animals were rendered hypovolemic via a 30% volume bleed. Upon confirmation of death, animals underwent immediate clamshell thoracotomy and aortic cross-clamping followed by 5 min of OCM. A catheter suitable for OCSAAP was then inserted into the aorta and animals underwent 1 min of OCSAAP at a rate of 10 mL/kg/min. Aortic and right atrial pressures were recorded continuously using solid-state blood pressure catheters. Representative 10-s intervals from each resuscitation method were extracted. Hemodynamic parameters including AoP-RAP gradients and CPPs were calculated and compared.

Results

At baseline, time from death to intervention was significantly shorter for OCM. However, mean CPPs and AoP-RAP gradients were significantly higher in animals undergoing OCSAAP. 98% of OCSAAP segments had a mean CPP > 15, compared to 35% of OCM intervals. While OCM had a significant negative correlation between time to intervention and maximum CPP, this correlation was not significant for OCSAAP.

Conclusion

OCSAAP generates favorable and potentially time-resistant pressure gradients when compared to those generated by OCM. Further investigation of the technique of OCSAAP is warranted, as it may have potential utility as a therapy during resuscitative thoracotomy (RT).

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Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Abbreviations

AoP:

Aortic root pressure

AoP-RAP:

Aortic root pressure to right atrial pressure

CI:

Confidence interval

CPP:

Coronary perfusion pressure

CPR:

Cardiopulmonary resuscitation

ECA:

Exsanguination cardiac arrest

MAP:

Mean arterial pressure

OCM:

Open cardiac massage

OCSAAP:

Open chest selective aortic arch perfusion

RAP:

Right atrial pressure

REBOA:

Resuscitative endovascular balloon occlusion of the aorta

ROSC:

Return of spontaneous circulation

RT:

Resuscitative thoracotomy

SAAP:

Selective aortic arch perfusion

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Acknowledgements

Sponsors had no involvement in study design, data collection/analysis, manuscript writing, and decision to submit for publication.

Funding

Funder Name: Uniformed Services University of Health Sciences. Grant Number: HU00011920072.

Author information

Authors and Affiliations

  1. Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA

    Joseph Edwards, Hossam Abdou, Neerav Patel, Eric Lang, Michael J. Richmond, Thomas M. Scalea & Jonathan J. Morrison

  2. Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Todd E. Rasmussen

Authors
  1. Joseph Edwards
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  2. Hossam Abdou
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  4. Eric Lang
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  8. Jonathan J. Morrison
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Contributions

JE conceptualization, methodology, investigation, writing—original draft, writing—review and editing, and formal analysis. HA investigation, writing—review and editing. NP investigation, writing—review and editing. EL investigation; writing—review and editing. MJR investigation, resources, writing—review and editing, and project administration. TER conceptualization; writing—review/editing. TMS conceptualization; writing—review/editing. JJM conceptualization, methodology, verification, and writing—review/editing.

Corresponding author

Correspondence to Jonathan J. Morrison.

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None.

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The study protocol was conducted in line with the policies instituted by the Institutional Animal Care and Use Committee.

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Edwards, J., Abdou, H., Patel, N. et al. Open chest selective aortic arch perfusion vs open cardiac massage as a means of perfusion during in exsanguination cardiac arrest: a comparison of coronary hemodynamics in swine. Eur J Trauma Emerg Surg 48, 2089–2096 (2022). https://doi.org/10.1007/s00068-021-01810-0

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