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

项目总结/摘要 美国每年有50万人心脏骤停。许多患者最初可能 从逮捕中复苏，但随后在医院死亡，或因 脑缺血心脏骤停护理期间使用的主要药物肾上腺素已被证明 提高心脏重新启动的机会，但有证据表明，它使神经系统 由于脑血管系统中的血管收缩，结果更差。可以改善血液的新疗法 在心肺复苏过程中流向心脏和大脑，然后在心脏复苏后保持增加的灌注。 重新启动，是必须的。这项研究将测试一种新的血管内治疗，可以增加心脏灌注 和大脑，并减少心脏重新启动后对肾上腺素的需求。血管内灌注 重症监护增强，EPACC，是一种小型主动脉球囊导管， 从股动脉进入近端降主动脉仅使用球囊的部分膨胀，该装置就像 主动脉中的“电阻器”，用于控制球囊上方的血压，同时继续允许血流通过 气球球囊充盈和回缩通过一系列算法实现自动化，这些算法允许球囊 根据患者的生理状况快速调整球囊体积运动。最近在猪模型中进行的一项小型试点研究， 心搏骤停的早期再停率由60%降至0 在心脏重新跳动之后这项研究将模拟心脏骤停后复苏的前24小时， 在有和没有EPACC的心脏骤停的猪模型中进行护理。具体而言，本研究的目标1 将研究EPACC对心脏的影响和再停搏率，目标2将研究EPACC对 目的3将研究EPACC对球囊远端器官的影响。 这项拟议的工作将确定EPACC在心脏骤停后护理期间的潜在益处，并提供 为将来的临床试验打下基础。

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.