A comparison of models of non-traumatic and traumatic cardiac arrest in the context of the use of endovascular resuscitation: an experimental study

INTRODUCTION: The use of extracorporeal membrane oxygenation (ECMO) in cardiac arrest (CA) that is refractory to conventional resuscitation measures has made it possible to extend the time for decision-making about further treatment for patients who were previously considered hopeless. OBJECTIVES: The study aimed to experimentally evaluate the efficacy of the ECMO technique for returned of spontaneous blood circulation (ROSC) in biological specimens with traumatic (TCA) and non-traumatic (NTCA) CA. MATERIALS AND METHODS: The experiment involved 12 pigs, with an average weight of 54.0 (50.3–58.8) kg. After appropriate preparation and connection of the ECMO circuit, CA model was created. The NTCA group used an asphyxic CA, while the TCA group used a combination of 50 % controlled blood loss and vessel damage. Upon CA, mechanical chest compression was started for 10 minutes, and the heart rhythm was evaluated. If there were no spontaneous contractions, ECMO was initiated. In the TCA group, surgical hemostasis was performed after the onset of ECMO. In cases of ventricular fibrillation after ECMO started external defibrillation was done. If resuscitation were unsuccessful, even with ECMO started, biological death was declared. With the sustained ROSC, ECMO was discontinued and continued observation until the end of the experiment for at least 6 hours. RESULTS: ECMO promoted ROSC in all animals. However, only 2/12 animals achieve ROSC due to ECMO; while the rest require additional defibrillation to restore their blood circulation. The survival rate of animals in the NTCA group was 5/6, while in the TCA group it was 2/6 (p = 0.098). Complications were more common among animals with TCA, including abdominal compartment syndrome and pulmonary edema. CONCLUSIONS: The use of ECMO allows to achieve ROSC in all animals, regardless of the type of CA. Although the survival rate for animals with NTCA was higher than for those with TCA.