Venovenous extracorporeal membrane oxygenation with mechanical chest compression for cardiopulmonary resuscitation: A porcine model study

Abstract

Objective

To evaluate the effectiveness of venovenous (VV) extracorporeal membrane oxygenation (ECMO) using a dual-lumen cannula coupled with continuous mechanical chest compressions (cMCC) for cardiopulmonary resuscitation and compare it with venoarterial (VA) ECMO or cMCC only, in a preclinical model.

Methods

Twenty-three pigs were allocated into 3 experimental groups: cMCC using a LUCAS 3 compression device, VA-ECMO, and cMCC + VV-ECMO. After cannulation, ventricular fibrillation was induced and circulatory support initiated per allocation. Defibrillation occurred after 30 minutes of support initiation. Hemodynamic, echocardiographic, and laboratory measurements were collected at different timepoints. The primary outcome was the rate of return of spontaneous circulation (ROSC).

Results

ROSC was achieved in 1 of 8 of animals with cMCC only (13%), 5 of 7 (71%) animals with cMCC + VV-ECMO, and 8 of 8 (100%) animals with VA-ECMO. cMCC + VV-ECMO was associated with a significantly greater ROSC rate as compared with compressions alone (P = .04). Arterial oxygen tension was significantly greater with cMCC + VV-ECMO as compared with cMCC alone at all time points. After defibrillation, lactate was lower in the VA-ECMO group as compared with cMCC alone (5.1 mmol/L vs 8.6 mmol/L; P < .01) and in the VV-ECMO group (6.3 mmol/L vs 8.6 mmol/L; P = .06).

Conclusions

cMCC in association with VV-ECMO using a single dual-lumen femoral cannula may be a viable option of extracorporeal cardiopulmonary resuscitation, potentially leading to greater rates of ROSC when compared with cMCC alone. Additional studies are needed to determine whether this strategy could serve as an early alternative to VA-ECMO in the out-of-hospital cardiac arrest setting.