# Evaluation of systemic and cerebral hemodynamics after systematic and early extracorporeal cardiopulmonary resuscitation in swine

## TL;DR

Early use of ECPR in pigs after cardiac arrest led to worse blood flow to the brain and body compared to traditional CPR with epinephrine.

## Contribution

This study compares early ECPR and CCPR effects on hemodynamics in pigs, revealing ECPR's potential neurological drawbacks.

## Key findings

- ECPR groups had lower cerebral perfusion pressure and higher pressure reactivity index after ROSC.
- ECPR was associated with increased norepinephrine use and blood lactate levels compared to CCPR.
- Survival was higher with CCPR at 10 minutes but not at 30 minutes post-arrest.

## Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) is thought to be efficient when performed promptly after cardiac arrest. However, its neurological benefit remains questionable if applied very early and systematically. Accordingly, we sought to compare systemic and cerebral hemodynamics when ECPR was implemented systematically compared to conventional cardiopulmonary resuscitation (CCPR) with epinephrine.

Following 5 min of untreated ventricular fibrillation, pigs were randomly submitted to CCPR with epinephrine or crystalloid-primed ECPR after either a 10- or 30-min low-flow (4 groups: CCPR 10′, ECPR 10′, CCPR 30′ and ECPR 30′. Defibrillations were then delivered until the return of spontaneous circulation (ROSC). Swine were followed 240 min from cardiopulmonary onset.

Six pigs were included in each group. Survival rate was higher in CCPR 10′ group vs ECPR 10′ (6/6 vs 2/6; p = 0.02) but not significantly different between CCPR 30′ and ECPR 30′ groups (2/6 vs 0/6; p = 0.53). In ECPR 10′ and 30′ groups, ECPR was associated with lower cerebral perfusion pressure, lower jugular venous oxygen saturation and higher-pressure reactivity index after ROSC, as compared to CCPR 10′ and 30′. A decrease in mean arterial pressure, along with an increase in norepinephrine dose and blood lactate level were also found in ECPR 10′ and 30′ groups after ROSC, as compared to CCPR 10′ and 30′.

The early and systemic implementation of ECPR after either a 10- or 30-min low-flow was associated with impaired cerebral and systemic hemodynamics after ROSC, as compared to CCPR with epinephrine.