SAAP & Intra-aortic Adrenaline in Cardiac Arrest

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Authors: Dave Mcreary, James Manning / Codes: CMP2, HAP26, HMP2 / Published: 10/04/2015

This years Douglas Chamberlain lecture at the LCAS was given by Prof. James Manning on his 25 years of research into cardiac arrest and the use of Selective Aortic Arch Perfusion in its management.

Basically (very basically) this is a process of gaining central arterial access in an arrested patient, floating a balloon catheter into the thoracic aorta, inflating it to form an occlusion and infusing an oxygenated fluid (currently blood) up the catheter to perfuse the heart and the brain. The theoretical benefit being that this provides supra-normal cardiac perfusion and should make ROSC more attainable, whilst helping to preserve neurological function.

In this podcast, we also discuss Prof. Mannings other area of interest the use of intra-aortic adrenaline in cardiac arrest. Current practice with the use of large doses of peripheral IV adrenaline is certainly being called into question which a placebo controlled trial currently underway to formally evaluate its effectiveness. The likely problem with IV adrenaline being that it is delivered to the wrong side of the circulatory system, with only small amounts of given doses making it through to the arterial side. If ROSC is then achieved then these large doses can circulate to potentially toxic effect.

Delivering dilute adrenaline directly into the thoracic aorta (while measuring the IABP through the same line) can allow much more controlled titration of adrenaline, and this could potentially be more effective than shot-gunning large doses in intravenously.

Professor Manning obviously describes both of these principals far more eloquently than I, so youre probably better just listening to the podcast

If this doesnt quite satisfy your curiosity however, you can hear more on the subject from the great EMCrit Podcast here and you can see Prof. Mannings lecture at Sydney HEMS.

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