Selective aortic arch perfusion vs. conventional advanced cardiac life support: a bi-ventricular pressure-volume loop analysis in a swine model of cardiac arrest

ABSTRACTBackgroundSelective Aortic Arch Perfusion (SAAP) is a resuscitative technique that aims to enhance myocardial and cerebral perfusion during cardiac arrest. While it has demonstrated promise in traumatic and hemorrhagic models, its physiological impact in medical cardiac arrest and its integration into conventional resuscitation protocols remain unexplored.MethodsA randomized preclinical study was performed in a swine model of ventricular fibrillation cardiac arrest to compare SAAP-assisted resuscitation with conventional Advanced Cardiac Life Support (ACLS). Ten Yorkshire swine were randomized to receive either SAAP (n=5) or ACLS (n=5). SAAP was successfully integrated into the CPR cycle using a bidirectional extracorporeal circuit. Cardiac performance was assessed using bi-ventricular pressure-volume loop (BV-PVL) and coronary perfusion pressure (CPP) analysis.ResultsSustained return of spontaneous circulation (ROSC) was achieved in 1 of 5 SAAP animals and 3 of 5 ACLS animals. Median survival time was longer in the ACLS group (180 vs 20 minutes; p=0.28). CPP >15 mmHg was maintained for a median of 15% of the resuscitation time in SAAP animals, compared to 100% in ACLS animals (p=0.22). Post-ROSC, left ventricular preload recruitable stroke work increased in both groups, while right ventricular function declined in the SAAP group, suggesting right heart strain.ConclusionsThis study presents the first successful integration of SAAP into an ACLS-compatible CPR protocol in a medical cardiac arrest model. Despite technical feasibility, the approach was associated with reduced ROSC and right ventricular dysfunction, underscoring the need for further protocol refinement prior to clinical application. KEYWORDSSelective perfusion, cardiac arrest, resuscitation, SAAP, pressure-volume loop, ROSC, hemodynamics HIGHLIGHTSFirst use of BV-PVL analysis to assess SAAP in medical cardiac arrestSAAP showed a reduced ROSC rate vs ACLS and evidence of RV strainCPP >15 mmHg rarely achieved during SAAP resuscitation cyclesLV contractility improved post-ROSC in both SAAP and ACLS groupsFindings support refinement of SAAP delivery in future protocols