• Mohamad Hakam Tiba, Takahiro Nakashima, Brendan M McCracken, Cindy H Hsu, Adam L Gottula, Nicholas L Greer, Traci A Cramer, Nadia R Sutton, Kevin R Ward, and Robert W Neumar.
• Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States; The Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, United States. Electronic address: tibam@umich.edu.
• Resuscitation. 2023 Aug 1; 189: 109885109885.

AimTo investigate the effect of tandem use of transient balloon occlusion of the descending aorta (AO) and percutaneous left ventricular assist device (pl-VAD) during cardiopulmonary resuscitation in a large animal model of prolonged cardiac arrest.MethodsVentricular fibrillation was induced and left untreated for 8 minutes followed by 16 minutes of mechanical CPR (mCPR) in 24 swine, under general anesthesia. Animals were randomized to 3 treatment groups (n = 8 per group): A) pL-VAD (Impella CP®) B) pL-VAD+AO, and C) AO. Impella CP® and the aortic balloon catheter were inserted via the femoral arteries. mCPR was continued during treatment. Defibrillation was attempted 3 times starting at minute 28 and then every 4 minutes. Haemodynamic, cardiac function and blood gas measurements were recorded for up to 4 hours.ResultsCoronary perfusion pressure (CoPP) in the pL-VAD+AO Group increased by a mean (SD) of 29.2(13.94) mmHg compared to an increase of 7.1(12.08) and 7.1(5.95) mmHg for groups pL-VAD and AO respectively (p = 0.02). Similarly, cerebral perfusion pressure (CePP) in pL-VAD+AO increased by a mean (SD) of 23.6 (6.11), mmHg compared with 0.97 (9.07) and 6.9 (7.98) mmHg for the other two groups (p < 0.001). The rate of return of spontaneous heartbeat (ROSHB) was 87.5%, 75%, and 100% for pL-VAD+AO, pL-VAD, and AO.ConclusionCombined AO and pL-VAD improved CPR hemodynamics compared to either intervention alone in this swine model of prolonged cardiac arrest.Copyright © 2023 Elsevier B.V. All rights reserved.

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