Heart Disease :: Increasing survival in cardiac arrest

Researchers are taking cardiac devices already in the operating room and using them in radically different applications as extracorporeal life support systems in cardiac arrest or traumatic hemorrhage.

Four systems were highlighted in the PreSessions Resuscitation Science Symposium on Saturday.

The question each research group addressed was what can be done to restore patients to life after their heart, brain and blood supply have stopped.

?Currently our best options of CPR and defibrillation?both of which work for a period of time?can be limited in certain situations,? said Lance B. Becker, M.D., professor of emergency medicine and director of the Center for Resuscitation Science, at the Hospital of the University of Pennsylvania, Philadelphia.

These new approaches apply existing technology in cardiac arrest or traumatic hemorrhage to preserve the heart and brain, said session co-moderator Vinay M. Nadkarni, M.D., associate professor of anesthesiology and critical care at the University of Pennsylvania. The morning?s highlight was a report from Japan on a streamlined system of care using both percutaneous extracorporeal cardiac bypass support and hypothermia from first responders to the specialized clinic.

Ken Nagao, M.D., director-in-chief of emergency and critical care medicine at Surugadai Nihon University Hospital, Tokyo, reported that intact neurologic survival quadrupled to an overall rate of 15 percent.

?By comparison, that would be three to four to five times better than any American city?s survival rate,? said Dr. Becker said.

?The data from Tokyo suggest that the window of opportunity to get a paramedic to a patient, provide cooling and CPR may be as long as 20 minutes,? he said. ?If that turns out to be true, we could change our survival rates from single digits to 30 percent and 40 percent ? it?s a revolution in the whole field of resuscitation.?

From the U.K., the technique of percutaneous bypass for cardiac arrest, already in limited clinical use around the world, was discussed by Ravindranath Tiruvoipati, M.D., clinical research fellow in the CESAR (Conventional Ventilation or ECMO for Severe Adult Respiratory Failure) Clinical Coordinating Center at Glenfield Hospital, Leicester.

Also from the U.K., Kate Brown, M.D., attending physician in pediatric cardiac intensive care at Great Ormand Street Hospital for Children, London, described using ECMO for children in cardiac arrest.

Dr. Becker noted that the researchers saw remarkable results when selected patients received expert care with basic CPR to preserve blood flow during cardiac arrest, and extracorporeal therapies allowed for good long-term outcomes.

Samuel A. Tisherman, M.D., associate professor of surgery and critical care medicine at the University of Pittsburgh Medical Center, used animal models to show potential future applications of percutaneous bypass for hemorrhagic shock, seeing good neurological outcomes after a long period of traumatic cardiac arrest.


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