Selective Aortic Arch Perfusion in CA lec Flashcards
How are coronary arteries perfused normally?
In diastole, retrograde blood flow through the coronary ostia.
What happens to coronary perfusion in VF?
Aortic valve is shut -> no perfusion
Define CPP
Coronary Perfusion Pressure: difference between aortic diastolic pressure and left ventricular diastolic pressure.
Normal range of CPP?
60-80mmHg
Minimum CPP for ROSC?
15 mmHg
How does SAAP work?
Balloon catheter inserted into proximal descending aorta -> isolates perfusion to heart and brain.
Catheter - central lumen which allows infusion of fluids - blood/perflubron and HBOC-201, and drugs - adrenaline and ?reperfusion injury in the future?
What are the aims of SAAP?
To reverse myocardial ischaemia and acidosis.
To enhance myocardial electrical activity and contractility.
To restore arterial vasomotor tone.
What equipment needed to perform SAAP?
- Blood (or oxygen-carrying fluid – e.g. Perflubron, HBOC-201)
- Membrane oxygenator
- SAAP catheter
- Introducer
- PPE
Surface landmark for femoral artery insertion?
mid-inguinal point: midpoint between ASIS and pubic tubercle.
Indications for SAAP?
• Cardiac or haemorrhagic cardiac arrest o Hypovolaemia o Hypoxia o Hypothermia o Hyper/hypokalaemia o H+ (acidosis) o Hypoglycaemia o Toxins o Tamponade o Tension pneumothorax o Thrombosis
Complications of SAAP
Pulmonary oedema, cerebral oedema, aortic dissection/rupture, catheter misplacement, air embolism, femoral arterial injury, thrombosis, wound infection and haematoma.
Pros of SAAP?
Minimally invasive compared to other “failed CPR techniques”.
Quick insertion time.
Perfusion of oxygen carrying fluid
Titration of drugs.
Cons of SAAP?
No human trials.
Not tested in animals with coronary artery disease.
Volume overload in the right atrium.
No long-term survival data.
some of the authors involved in the animal research?
Mannung, Barnard, Ross, Batson
