The Future

ECPB Mitochondrial Medicine Suspended Animation Regionalized Care

ECPB Emergency Cardio-Pulmonary Bypass

ECPB circuit
Cardiopulmonary Bypass:
Innovative strategy for treating cardiac arrest Bridge until native cardiac output is restored In expert hands, can be rapidly initiated to maintain circulation

Nichol et al. Resuscitation, 2006

Sudden cardiac death: directing the scope of resuscitation towards the heart and brain CPR with monitoring of blood pressure Cardiopulmonary bypass Prompt diagnosis and treatment Limit further damage post-arrest
amino acid-enhanced cardioplegia mild systemic hypothermia

Athanasuleas et al. Resuscitation, 2006

Results
34 cardiac arrest patients 3 out-of-hospital 17 in cath lab s/p PCI 4 in OR s/p cardiac surgery 10 in ICU s/p CABG 27/34 survived to hospital discharge 25/34 with good neurological outcome
Athanasuleas et al. Resuscitation, 2006

SAVE-J Trial
Prospective Case Control Trial Design:
10-15 programs performing ECPB 10-15 programs not performing ECPB 120 patients in ECPB group and 240 controls

Inclusion criteria:
No ROSC after 10-15 minutes of ED-based CPR VF arrest Doesnt have to be witnessed > 20 years old; < 75 years old < 60 minutes arrest time prior to attempt @ ECPB

Save-J: Preliminary Results

Control group patients:
Continued conventional CPR TH if they have ROSC Hemodynamic Optimization Strategy

Start date: 10/08 Neurologically-intact survival:

12.3% in ECPB group 1.8% in conventional CPR group