The journal of trauma and acute care surgery · 2026
Aortic cardiopulmonary resuscitation in trauma: Extracorporeal CPR with controlled reoxygenation outperforms resuscitative thoracotomy in a porcine model of exsanguination arrest.
СтатьяНазвание и аннотация: Перевод в очереди
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Lackie Meredith, Amberman Keith, Patterson Kyle, Mares John, Hutzler Justin, Tiwari Namrata, Killingsworth Zaria, Snowden Delaney, Green J T, Do Woo, Morrison Jonathan, Powell Elizabeth, Radowsky Jason, Propper Brandon, Haigney Mark, Bradley Matthew, Burmeister David, Walker Patrick, Bethesda, Maryland
Аннотация
BACKGROUND: Exsanguination cardiac arrest (ECA) remains a formidable challenge in trauma surgery with a persistently dismal prognosis. Extracorporeal cardiopulmonary resuscitation (ECPR) has shown promise in medical cardiac arrest and may translate to trauma. We hypothesized that aortic cardiopulmonary resuscitation in trauma (ACT)-a controlled ECPR approach aimed at mitigating reperfusion injury-would improve sustained return of spontaneous circulation (ROSC) compared with resuscitative thoracotomy (RT) in a porcine ECA model.
METHODS: Twelve swine were bled to mean arterial pressure <20 mm Hg and end-tidal CO 2 <10 mm Hg for 1 minute, defining ECA. After 10 minutes of ECA, animals received one of two pre-assigned interventions: (1) control with RT, aortic cross-clamp, open cardiac massage, intravenous whole blood transfusion, and 100% FiO 2 (n=6) or (2) ACT, involving venoarterial extracorporeal membrane oxygenation (VA-ECMO) with graded FiO 2 advancement and passive hypothermia (n=6). Both groups received a 30-minute resuscitation phase followed by a 90-minute critical care phase. The primary endpoint was ROSC-defined as mean arterial pressure >50 mm Hg with a sinus rhythm-at the end of the critical care period. Secondary outcomes included coronary and carotid flow to assess critical organ perfusion during resuscitation.
RESULTS: The primary endpoint was achieved in 100% of ACT animals versus 0% of controls ( p <0.001). All subjects showed pulseless electrical activity during ECA; 6/6 controls developed ventricular fibrillation during resuscitation compared with 2/6 in ACT ( p =0.060). During the critical care phase, ACT led to increased mean left-anterior-descending coronary artery flow (41.6±0.2 mL/min vs. 31.7±0.6 mL/min in RT) and right carotid artery flow (214.8±0.5 mL/min vs. 90.7±1.0 mL/min, both p <0.0001).
CONCLUSIONS: Following ECA, ACT produced a markedly higher rate of sustained ROSC compared with conventional RT and significantly augmented coronary and carotid perfusion-highlighting its potential as a trauma-focused ECPR modality.
LEVEL OF EVIDENCE: Preclinical-large animal model.
METHODS: Twelve swine were bled to mean arterial pressure <20 mm Hg and end-tidal CO 2 <10 mm Hg for 1 minute, defining ECA. After 10 minutes of ECA, animals received one of two pre-assigned interventions: (1) control with RT, aortic cross-clamp, open cardiac massage, intravenous whole blood transfusion, and 100% FiO 2 (n=6) or (2) ACT, involving venoarterial extracorporeal membrane oxygenation (VA-ECMO) with graded FiO 2 advancement and passive hypothermia (n=6). Both groups received a 30-minute resuscitation phase followed by a 90-minute critical care phase. The primary endpoint was ROSC-defined as mean arterial pressure >50 mm Hg with a sinus rhythm-at the end of the critical care period. Secondary outcomes included coronary and carotid flow to assess critical organ perfusion during resuscitation.
RESULTS: The primary endpoint was achieved in 100% of ACT animals versus 0% of controls ( p <0.001). All subjects showed pulseless electrical activity during ECA; 6/6 controls developed ventricular fibrillation during resuscitation compared with 2/6 in ACT ( p =0.060). During the critical care phase, ACT led to increased mean left-anterior-descending coronary artery flow (41.6±0.2 mL/min vs. 31.7±0.6 mL/min in RT) and right carotid artery flow (214.8±0.5 mL/min vs. 90.7±1.0 mL/min, both p <0.0001).
CONCLUSIONS: Following ECA, ACT produced a markedly higher rate of sustained ROSC compared with conventional RT and significantly augmented coronary and carotid perfusion-highlighting its potential as a trauma-focused ECPR modality.
LEVEL OF EVIDENCE: Preclinical-large animal model.