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. 2022 Apr 11;11(8):2111.
doi: 10.3390/jcm11082111.

Beneficial Effects of Adjusted Perfusion and Defibrillation Strategies on Rhythm Control within Controlled Automated Reperfusion of the Whole Body (CARL) for Refractory Out-of-Hospital Cardiac Arrest

Sam Joé Brixius  1 , Jan-Steffen Pooth  1 , Jörg Haberstroh  2 , Domagoj Damjanovic  1 , Christian Scherer  1 , Philipp Greiner  1 , Christoph Benk  1 , Friedhelm Beyersdorf  1 , Georg Trummer  1
Affiliations

Beneficial Effects of Adjusted Perfusion and Defibrillation Strategies on Rhythm Control within Controlled Automated Reperfusion of the Whole Body (CARL) for Refractory Out-of-Hospital Cardiac Arrest

Sam Joé Brixius et al. J Clin Med. .

Abstract

Survival and neurological outcomes after out-of-hospital cardiac arrest (OHCA) remain low. The further development of prehospital extracorporeal resuscitation (ECPR) towards Controlled Automated Reperfusion of the Whole Body (CARL) has the potential to improve survival and outcome in these patients. In CARL therapy, pulsatile, high blood-flow reperfusion is performed combined with several modified reperfusion parameters and adjusted defibrillation strategies. We aimed to investigate whether pulsatile, high-flow reperfusion is feasible in refractory OHCA and whether the CARL approach improves heart-rhythm control during ECPR. In a reality-based porcine model of refractory OHCA, 20 pigs underwent prehospital CARL or conventional ECPR. Significantly higher pulsatile blood-flow proved to be feasible, and critical hypotension was consistently prevented via CARL. In the CARL group, spontaneous rhythm conversions were observed using a modified priming solution. Applying potassium-induced secondary cardioplegia proved to be a safe and effective method for sustained rhythm conversion. Moreover, significantly fewer defibrillation attempts were needed, and cardiac arrhythmias were reduced during reperfusion via CARL. Prehospital CARL therapy thus not only proved to be feasible after prolonged OHCA, but it turned out to be superior to conventional ECPR regarding rhythm control.

Keywords: cardiopulmonary resuscitation; extracorporeal circulation; post-resuscitation care.

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Conflict of interest statement

F.B., C.B. and G.T. are shareholders in Resuscitec GmbH, Freiburg, Germany, which is a start-up company of the University Medical Centre Freiburg. J.-S.P., S.J.B., P.G., D.D. and C.S. are part-time employees of Resuscitec GmbH, Freiburg, Germany. The remaining authors have disclosed that they have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Schematic presentation of the experimental protocol. CA Cardiac arrest, BLS Basic life support, ALS Advanced life support, FiO2 Fraction of inspired oxygen, VT Tidal volume, C/V Chest compression to ventilation ratio, BR Breathing rate.
Figure 2
Figure 2
Pulsatile blood flow on ECC during CARL therapy: (a) Screenshot from real-time measurements on the CARL controller during asystole reperfusion. A pulsatile blood pressure was observed during extracorporeal circulation in the ascending aorta during asystole phase (red curve); (b) Screenshot of experimental monitoring during ECC. Despite asystole (green curve), a pulsatile blood flow (red curve) is detected in the common carotid. Pulmonary artery (PA) pressure is displayed in yellow.
Figure 3
Figure 3
Longitudinal course of haemodynamic parameters: (a) Mean arterial blood pressure; (b) Coronary perfusion pressure. Data are expressed as mean ± SD. BL Baseline, BLS Basic life support, ALS Advanced life support. (*** p < 0.001).
Figure 4
Figure 4
Haemoglobin concentration’s longitudinal course in arterial blood. Data are expressed as mean ± SD. BL Baseline, BLS Basic life support, ALS Advanced life support. (*** p < 0.001).
Figure 5
Figure 5
Number of shocks (200 J) delivered. Each point represents the number of electric defibrillations required per animal for sustained rhythm conversion to sinus rhythm (** p < 0.01).
See this image and copyright information in PMC

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