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Effect of levosimendan on cerebral oxygenation and perfusion in a swine model of cardiopulmonary resuscitation
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Abstracts / Resuscitation 118S (2017) e5–e42
Methods: Comatose patients who were transferred to 15 EDs in Japan after out-of-hospital cardiac arrest (OHCA) from 2011 to 2013 were assessed retrospectively. The primary outcome was all-cause mortality at 90 days after OHCA, and the secondary outcome was favorable neurologic function as evaluated according to cerebral performance categories (CPCs). Results: We stratified 315 comatose OHCA patients who achieved return of spontaneous circulation into three groups according to rSO2 on ED arrival: rSO2 ≤40% (n = 228), rSO2 41–60% (n = 42), and rSO2 ≥61% (n = 45). Propensity score analysis revealed that TTM at 32–34 ◦ C tended to decrease all-cause mortality in patients with rSO2 41–60% (average treatment effect [ATE] by propensity score matching [PSM] −0.64, 95%CI −0.82 to −0.46; ATE by inverse probability of treatment weighting [IPW] −0.64, 95%CI −0.86 to −0.43), and tended to increase favorable outcomes (CPCs 1 and 2) in patients with rSO2 41–60% (ATE by PSM 0.43, 95%CI −0.29 to 1.15; ATE by IPW 0.63, 95%CI 0.35–0.90). Conclusion: TTM at 32–34 ◦ C tends to decrease all-cause mortality in comatose OHCA patients with rSO2 41–60% on ED arrival. http://dx.doi.org/10.1016/j.resuscitation.2017.08.076 AS067 Effect of levosimendan on cerebral oxygenation and perfusion in a swine model of cardiopulmonary resuscitation Andreas Garcia Bardon 1,∗ , Jens Kamuf 1 , Alexander Ziebart 1 , Svenja Winzen 2 , Robert Kelm 1 , Kristin Engelhard 1 , Erik Hartmann 1 1 Department of Anaesthesiology, Universitätsmedizin Mainz, Mainz, Germany 2 Polymer Analysis Group, Max-Planck Institute for Polymer Research, Mainz, Germany
Background: Out-of-hospital cardiac arrest (CA) is highly associated with severe injury to the heart and brain and an overall survival of less than 10 percent. Levosimendan has been shown to reduce neuronal damage after CA. The present study aims to evaluate potential effects of levosimendan on cerebral oxygenation and perfusion after CA in German landrace pigs. Methods: After induction of CA via a pacing catheter and consecutive ventricular fibrillation (VF) for 7 min, a standard CPR was initated. Directly following return of spontaneous circulation (ROSC), 16 animals were randomized to receive levosimendan (12 g/kg directly followed by 0.3 g/kg/min) or the equivalent dosis of saline. Haemodynamic variables were measured before cardiac arrest, during arrest and resuscitation, and for 6 h after ROSC. Additionally, cerebral tissue oxygenation was measured via fluorimetry, cerebral oxygen saturation via spectrometry and regional cerebral blood flow via laser-doppler-flowmetry. Global perfusion was measured using fluorescent microspheres and highperformance liquid chromatography (HPLC). Results: Both experimental groups equaled concerning haemodynamic parameters, including cardiac output and cerebral oxygen saturation. Based on identical volume- and catecholamine therapy a significantly higher cerebral tissue oxygenation could be shown in the treatment group, starting as soon as 30 min after ROSC. Additionally, a higher renal blood perfusion could be found in the treatment group. No evidence of an effect on cerebral perfusion could be shown. Conclusion: The immediate application of levosimendan after ROSC leads to an augmented cerebral oxygenation and a higher renal perfusion after CA in German landrace pigs. This effect does
not seem to be the result of an improved cerebral perfusion, but potentially an additional effect of levosimendan on cerebral tissue. http://dx.doi.org/10.1016/j.resuscitation.2017.08.077 AS068 Diagnostic and therapeutic value of coronary angiography and CT-scan after extracorporeal cardiopulmonary resuscitation (eCPR) – A single center registry study Viviane Zotzmann 1,2,∗ , Tobias Wengenmayer 1,2 , Paul Biever 1,2 , Christoph Bode 1,2 , Dawid Staudacher 1,2 1 Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany 2 Extracorporeal Cardiovascular Research Group, Freiburg, Germany
Introduction: Implantation of a venoarterial extracorporeal membrane oxygenation (ECMO) in patients with ongoing cardiopulmonary resuscitation without return of spontaneous circulation (eCPR) can stabilize hemodynamics. Further diagnostic work up is needed in order to diagnose and treat the cause of the collapse. Patients after eCPR compromise a heterogeneous population with more severe underlying pathologies when compared to patients with return of spontaneous circulation. Aim of this study is the evaluation of the diagnostic value of coronary angiography and CT-scan after eCPR. Methods: All patients after eCPR treated at a single tertiary referral hospital between December 2010 and November 2015 were included in a retrospective registry study. Results: A total of 123 patients were considered (age 59.5 ± 15.3 years, low-flow time 59.0 ± 28.2 min, survival 11.4%). 52 patients presented with non-shockable rhythm (age 63.8 ± 16.1years, lowflow duration 51.0 ± 23.1 min, survival 15.4%) while 71 patients presented with either a shockable rhythm or ST-elevation (age 56.3 ± 14.0 years, low-flow duration 64.8 ± 30.2 min, survival 8.5% p < .01, <.01 and .03, respectively). Coronary angiography was performed significantly less frequent in patients with non-shockable rhythm (59.6% vs. 93.0% p < .01), see Fig. 1. A lesion deemed responsible for collapse however was found at similar rates in both groups (71.0% with non-shockable rhythm vs. 83.3% with ST-elevation or shockable rhythm, p = .18).
Fig. 1.
CT-scan was performed at similar rates in both groups (65.4% vs 50.7%, p = .14). Pathologies deemed responsible for collapse however were found more often in patients with non-shockable rhythm (23.5% vs. 0%, p < .01). CT-Scan yielded findings relevant to the further treatment frequently in both groups (92.2% vs 91.6%, p = 1). Cause of collapse could be detected by CT-scan at significantly lower
Abstracts / Resuscitation 118S (2017) e5–e42
Methods: Comatose patients who were transferred to 15 EDs in Japan after out-of-hospital cardiac arrest (OHCA) from 2011 to 2013 were assessed retrospectively. The primary outcome was all-cause mortality at 90 days after OHCA, and the secondary outcome was favorable neurologic function as evaluated according to cerebral performance categories (CPCs). Results: We stratified 315 comatose OHCA patients who achieved return of spontaneous circulation into three groups according to rSO2 on ED arrival: rSO2 ≤40% (n = 228), rSO2 41–60% (n = 42), and rSO2 ≥61% (n = 45). Propensity score analysis revealed that TTM at 32–34 ◦ C tended to decrease all-cause mortality in patients with rSO2 41–60% (average treatment effect [ATE] by propensity score matching [PSM] −0.64, 95%CI −0.82 to −0.46; ATE by inverse probability of treatment weighting [IPW] −0.64, 95%CI −0.86 to −0.43), and tended to increase favorable outcomes (CPCs 1 and 2) in patients with rSO2 41–60% (ATE by PSM 0.43, 95%CI −0.29 to 1.15; ATE by IPW 0.63, 95%CI 0.35–0.90). Conclusion: TTM at 32–34 ◦ C tends to decrease all-cause mortality in comatose OHCA patients with rSO2 41–60% on ED arrival. http://dx.doi.org/10.1016/j.resuscitation.2017.08.076 AS067 Effect of levosimendan on cerebral oxygenation and perfusion in a swine model of cardiopulmonary resuscitation Andreas Garcia Bardon 1,∗ , Jens Kamuf 1 , Alexander Ziebart 1 , Svenja Winzen 2 , Robert Kelm 1 , Kristin Engelhard 1 , Erik Hartmann 1 1 Department of Anaesthesiology, Universitätsmedizin Mainz, Mainz, Germany 2 Polymer Analysis Group, Max-Planck Institute for Polymer Research, Mainz, Germany
Background: Out-of-hospital cardiac arrest (CA) is highly associated with severe injury to the heart and brain and an overall survival of less than 10 percent. Levosimendan has been shown to reduce neuronal damage after CA. The present study aims to evaluate potential effects of levosimendan on cerebral oxygenation and perfusion after CA in German landrace pigs. Methods: After induction of CA via a pacing catheter and consecutive ventricular fibrillation (VF) for 7 min, a standard CPR was initated. Directly following return of spontaneous circulation (ROSC), 16 animals were randomized to receive levosimendan (12 g/kg directly followed by 0.3 g/kg/min) or the equivalent dosis of saline. Haemodynamic variables were measured before cardiac arrest, during arrest and resuscitation, and for 6 h after ROSC. Additionally, cerebral tissue oxygenation was measured via fluorimetry, cerebral oxygen saturation via spectrometry and regional cerebral blood flow via laser-doppler-flowmetry. Global perfusion was measured using fluorescent microspheres and highperformance liquid chromatography (HPLC). Results: Both experimental groups equaled concerning haemodynamic parameters, including cardiac output and cerebral oxygen saturation. Based on identical volume- and catecholamine therapy a significantly higher cerebral tissue oxygenation could be shown in the treatment group, starting as soon as 30 min after ROSC. Additionally, a higher renal blood perfusion could be found in the treatment group. No evidence of an effect on cerebral perfusion could be shown. Conclusion: The immediate application of levosimendan after ROSC leads to an augmented cerebral oxygenation and a higher renal perfusion after CA in German landrace pigs. This effect does
not seem to be the result of an improved cerebral perfusion, but potentially an additional effect of levosimendan on cerebral tissue. http://dx.doi.org/10.1016/j.resuscitation.2017.08.077 AS068 Diagnostic and therapeutic value of coronary angiography and CT-scan after extracorporeal cardiopulmonary resuscitation (eCPR) – A single center registry study Viviane Zotzmann 1,2,∗ , Tobias Wengenmayer 1,2 , Paul Biever 1,2 , Christoph Bode 1,2 , Dawid Staudacher 1,2 1 Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany 2 Extracorporeal Cardiovascular Research Group, Freiburg, Germany
Introduction: Implantation of a venoarterial extracorporeal membrane oxygenation (ECMO) in patients with ongoing cardiopulmonary resuscitation without return of spontaneous circulation (eCPR) can stabilize hemodynamics. Further diagnostic work up is needed in order to diagnose and treat the cause of the collapse. Patients after eCPR compromise a heterogeneous population with more severe underlying pathologies when compared to patients with return of spontaneous circulation. Aim of this study is the evaluation of the diagnostic value of coronary angiography and CT-scan after eCPR. Methods: All patients after eCPR treated at a single tertiary referral hospital between December 2010 and November 2015 were included in a retrospective registry study. Results: A total of 123 patients were considered (age 59.5 ± 15.3 years, low-flow time 59.0 ± 28.2 min, survival 11.4%). 52 patients presented with non-shockable rhythm (age 63.8 ± 16.1years, lowflow duration 51.0 ± 23.1 min, survival 15.4%) while 71 patients presented with either a shockable rhythm or ST-elevation (age 56.3 ± 14.0 years, low-flow duration 64.8 ± 30.2 min, survival 8.5% p < .01, <.01 and .03, respectively). Coronary angiography was performed significantly less frequent in patients with non-shockable rhythm (59.6% vs. 93.0% p < .01), see Fig. 1. A lesion deemed responsible for collapse however was found at similar rates in both groups (71.0% with non-shockable rhythm vs. 83.3% with ST-elevation or shockable rhythm, p = .18).
Fig. 1.
CT-scan was performed at similar rates in both groups (65.4% vs 50.7%, p = .14). Pathologies deemed responsible for collapse however were found more often in patients with non-shockable rhythm (23.5% vs. 0%, p < .01). CT-Scan yielded findings relevant to the further treatment frequently in both groups (92.2% vs 91.6%, p = 1). Cause of collapse could be detected by CT-scan at significantly lower