Femoral Vessel Occlusion Enhances Cardiac and Cerebral Perfusion in a Porcine Model of Cardiac Arrest.

Abstract

Background: Closed chest compressions during cardiopulmonary resuscitation (CPR) mechanically circulate blood to the organs during cardiac arrest, yet cardiac arrest remains among the most fatal diseases, with a mortality rate that exceeds 85% to 90% globally. Novel methodologies to improve organ perfusion, particularly in resource-restricted settings, are overdue. This study evaluated the efficacy of external femoral vessel occlusion (FVO) during CPR in a large mammal model.

Methods: Thirteen adult Yorkshire pigs were instrumented with vascular and electrophysiologic monitoring lines. Hemodynamic measures and cardiac and cerebral perfusion in the pre- and postarrest conditions were quantified via fluorescent microspheres infused into the circulation. Control (n=7) animals underwent routine CPR, whereas experimental (n=6) animals received CPR and FVO via external compression to the femoral vessels during the entirety of the 30-minute resuscitative phase. The primary outcome was mean arterial pressure, and secondary outcomes included cerebral and cardiac perfusion.

Results: During native heart function, external FVO demonstrated a significant increase in mean arterial pressure (73±3 versus 62±2 mm Hg, P<0.001). During cardiac arrest, animals undergoing CPR with FVO had a significantly higher mean arterial pressure compared with CPR alone (49±9 versus 32±3 mm Hg, P<0.001). CPR with FVO significantly increased cardiac (181 versus 80 mean fluorescence intensity, P=0.014) and cerebral perfusion (119 versus 27 mean fluorescence intensity, P<0.001).

Conclusions: CPR with FVO significantly increased mean arterial pressure, cardiac perfusion, and cerebral perfusion over CPR alone. These findings suggest FVO may represent a novel adjunctive strategy and therapeutic opportunity to enhance cerebral and cardiac perfusion, thereby decreasing cardiac arrest morbidity and mortality.