Endovascular blood pressure targeting in cardiac arrest, a translational research study

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PROJECT SUMMARY / ABSTRACT 500,000 people in the United States suffer from a cardiac arrest every year. Many patients may be initially resuscitated from the arrest but go on to die later in the hospital or to have a poor neurologic outcome from cerebral ischemia. The primary medication used during cardiac arrest care, epinephrine, has been proven to improve the chance that the heart will restart, but there is developing evidence that it makes neurologic outcomes worse due to vasoconstriction in the cerebral vasculature. New therapies that can improve blood flow to the heart and to the brain during CPR, and then maintain that increased perfusion after the heart restarts, are needed. This study will test a new endovascular therapy that can augment perfusion to the heart and brain and to decrease epinephrine requirements after the heart has restarted. Endovascular Perfusion Augmentation for Critical Care, EPACC, is a small aortic balloon catheter that is placed retrograde from the femoral artery into the proximal descending aorta. Using only partial inflation of the balloon, the device acts like a “resistor” in the aorta to control blood pressure above the balloon while continuing to permit flow past the balloon. Balloon inflation and deflation is automated through a series of algorithms that allow the balloon to rapidly tailor balloon volume movements to the patient’s physiology. A recent small pilot study in a pig model of cardiac arrest demonstrated that EVAC can decrease the rate of rearrest from 60% to 0% in the early period after the heart has restarted. This study will model the first 24 hours of post-arrest resuscitation and critical care in a pig model of cardiac arrest with and without EPACC. Specifically, Aim 1 of this proposed research will study the effects of EPACC on the heart and the rate of rearrest, Aim 2 will study the effects of EPACC on the brain and on cerebral perfusion, and Aim 3 will study the effects of EPACC on organs distal to the balloon. This proposed work will identify the potential benefits of EPACC during post-cardiac arrest care and provide the foundation for future clinical trials if found to be effective.