Supplement

Promising First Results of a Newly Developed Percutaneous Left Ventricular Assist Device in a Large Animal Model of Cardiac Arrest

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Support: The development of this supplement was funded by Abiomed.

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Dr Billig’s research focuses on investigating the efficacy of the use of percutaneous left ventricular assist devices (pLVADs) in cardiac arrest. Dr Billig emphasised that previous work has shown that survival after cardiac arrest improves with use of a pLVAD over chest compressions, but the uptake of this strategy has been limited because of the complex nature of insertion techniques requiring a guidewire. Dr Billig’s current research aims were to evaluate the placement of the new expandable pLVAD, the Impella ECP, without a guidewire and to test its efficacy for resuscitation in cardiac arrest using a porcine model. The group tested two versions of the Impella ECP, one without a modified catheter and one with a modified catheter to better fit the swine anatomy. Cardiac arrest was induced in six pigs (75 kg) with electrical fibrillation for 5 minutes; the pigs were then resuscitated with either a non-modified or modified Impella ECP inserted through a 10 Fr sheath and norepinephrine added prior to defibrillation. After return of spontaneous circulation was observed, the pigs were followed up for 5 hours before the devices were explanted and cardiac function was evaluated. The guidewire-less pLVAD insertion was monitored under transoesophageal echocardiography (TOE). Dr Billig showed a representative TOE to demonstrate the ease and speed of aortic value crossing and positioning of the device without a guidewire.

Dr Billig described the initial results of this study comparing the use of a non-modified versus modified Impella ECP. Insertion was successful in all six animals without the guidewire, with a mean (± SD) time of 58 ± 21 seconds from the start of insertion to pump activation. Although the non-modified version successfully resuscitated one of three pigs, the modified Impella ECP successfully resuscitated all three pigs. Dr Billig reported that a mean (± SD) of 2.25 ± 1.50 defibrillations and 1.5 ± 0.6 mg norepinephrine were required for resuscitation. There were no adverse events due to the new Impella device, including aortic regurgitation after explant. In animals with the Impella ECP, blood pressure increased markedly 10 minutes after the return of spontaneous circulation compared with baseline, which was followed by a drop and return to stable haemodynamics that was maintained throughout the 5 hours of support and at 1 hour after device explant. Similarly, sufficient lactate clearing was observed, with levels returning to baseline even after device explant.

Dr Billig concluded that guidewire-free device placement is feasible and simple to perform with the new Impella device, and therefore likely to result in fewer complications and better patient outcomes in cardiac arrest.