Identification of cerebral perfusion targets during extracorporeal resuscitation

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Despite continuous efforts to optimize the care of resuscitation patients, on average only 8% of all patients survive out-of-hospital resuscitation and can be discharged from the hospital alive. A large number of these resuscitation patients also exhibit persistent neurological functional impairments in the event of successful resuscitation. Various studies have already demonstrated that only insufficient cerebral blood flows are achieved during conventional cardiopulmonary resuscitation using chest compressions. These insufficient flows contribute to the aggravation of reperfusion injury after ischemia.To improve reperfusion after cardiac arrest, extracorporeal pump systems have been increasingly used in resuscitation in recent years (called eCPR).In selected patients, superiority of eCPR compared to conventional resuscitation has already been demonstrated. However, eCPR remains a largely undefined therapeutic approach. While there are clear recommendations for conventional resuscitation, there are still no recommendations or target criteria for eCPR. Due to this lack of therapeutic recommendations, different reperfusion flows are often targeted in clinical practice.The neurological damage resulting from resuscitation consists of an ischemia component as well as a reperfusion component. It is known that during reperfusion after global cerebral ischemia or after cardiac arrest, cerebral areas can be observed that do not show perfusion even despite restoration of a systemic circulation with physiological blood flows. This phenomenon is called the no-reflow phenomenon. To date, the exact pathomechanism of this phenomenon remains unclear. In the past, changes of the to be perfused tissue on the one hand and changes of the perfusing blood on the other hand have been discussed.In our Freiburg porcine resuscitation model, we have now for the first time succeeded in demonstrating a reversibility of the no-reflow phenomenon using an extracorporeal circulation system (ECC) with high extracorporeal flows.This reversibility of the no-reflow phenomenon raises the question of the extent to which a high reperfusion flow or even known side effects of extracorporeal circulation influence the no-reflow phenomenon. This will be investigated in this project.Our model offers the possibility to investigate the mechanism of the no-reflow phenomenon and to collect information for the clinical use of ECCs in resuscitation at the same time.