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

心脏骤停中的血管内血压目标，一项转化研究

• 批准号: 10693924
• 负责人: Michael Austin Johnson
• 金额: $ 55.75万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693924
• 关键词: Algorithms; Animals; Aorta; Automation; Biological Markers; Blood Pressure; Blood Vessels; Blood flow; Brain; Cardiac; Cardiopulmonary Resuscitation; Caring; Case Series; Catheters; Cell Death; Cerebral Ischemia; Cerebrovascular system; Cerebrum; Circulation; Clinical; Clinical Research; Clinical Trials; Coronary; Critical Care; Data; Descending aorta; Devices; Discipline of obstetrics; Distal; Epinephrine; Equipment; Extracorporeal Membrane Oxygenation; Foundations; Future; Goals; Heart; Heart Arrest; Heart Injuries; Hemorrhage; Histologic; Histology; Hospitals; Hour; Intervention; Laboratories; Lasers; Measures; Methods; Modeling; Movement; Nervous System Physiology; Neurologic; Neurological outcome; Neuronal Injury; Organ; Output; Patients; Performance; Perfusion; Persons; Pharmaceutical Preparations; Physiology; Pilot Projects; Public Health; Renal function; Research; Resuscitation; Series; Shapes; Shock; Technology; Testing; Tissues; Titrations; Transesophageal Echocardiography; Translational Research; Trauma; United States; Urine; Ventricular Fibrillation; Work; blood pressure control; cerebral ischemic injury; coronary perfusion; emergency settings; experimental study; femoral artery; health care settings; heart function; hemodynamics; improved; improved outcome; innovation; interest; ischemic injury; magnetic resonance imaging biomarker; myocardial injury; neuron loss; novel therapeutics; organ injury; pharmacologic; porcine model; prevent; rearrest; renal artery; research study; standard of care; survival outcome; translational study; vasoconstriction

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.

项目摘要 /摘要 美国每年有50万人患心脏骤停。许多患者最初可能是 从逮捕中复活，但后来在医院死亡或从 脑缺血。心脏骤停过程中使用的主要药物肾上腺素已被证明为 提高心脏重新启动的机会，但是有发展的证据表明它使神经系统 由于脑血管中的血管收缩而导致的结果更糟。可以改善血液的新疗法 在心肺复苏期间流向心脏和大脑，然后保持心脏后增加的灌注 需要重新启动。这项研究将测试一种新的血管内疗法，可以增强心脏灌注 和大脑，以减少心脏重新启动后的肾上腺素需求。血管内灌注 重症监护的增强，EPACC，是一个小的主动脉气球导管，从 股动脉进入近端主动脉。仅使用气球的部分通胀，设备就像 主动脉中的“电阻器”控制气球上方的血压，同时继续流过 气球。气球通货膨胀和放气是通过一系列算法自动化的，这些算法使气球得以实现 迅速量身定制的气球体积动作到患者的生理学上。最近在猪模型中的一项小型试点研究 心脏骤停表明，EVAC可以在早期降低60％ 心脏重新开始后。这项研究将模拟逮捕后复苏和关键的前24小时 在有或没有EPACC的心脏骤停模型中护理。具体而言，目的1这项拟议的研究 将研究EPACC对心脏和重新质率的影响，AIM 2将研究EPACC对 大脑和大脑灌注和AIM 3将研究EPACC对气球远端器官的影响。 这项拟议的工作将确定EPACC在后心脏骤停期间的潜在好处，并提供 如果发现有效的话，将来的临床试验基础。