Regional cerebral blood flow with manual internal cardiac massage versus direct mechanical ventricular assistance

Previous studies have not discerned the best method for generating regional cerebral blood flow during internal cardiac massage. We hypothesized that regional cerebral blood flow generated by a mechanical method — direct mechanical ventricular assistance (DMVA) — would be superior to manual internal cardiac massage (MAN). Twelve adult Yucatan minipigs weighing more than 44 kg each were studied. Swine were instrumented for regional cerebral blood flow measurements using tracer microspheres. After 15 minutes of ventricular fibrillation, swine were randomized to receive either MAN or DMVA. Regional cerebral blood flow was measured during normal sinus rhythm and at one minute (VF-1) and six minutes (VF-2) after initiation of circulatory support Regional cerebral blood flow values were compared using a Wilcoxon rank sum test. During VF-1, there was a tendency for DMVA to produce greater regional cerebral blood flow than MAN, although these differences were not statistically significant (DMVA vs MAN as mL/min/100 g): cerebral cortex, 28 versus 11; cerebellum, 49 versus 22; midbrain, 43 versus 16; pons, 55 versus 18; medulla, 55 versus 19; and spinal cord, 33 versus 10. During VF-2, DMVA produced greater regional cerebral blood flows than were produced by MAN: cerebral cortex, 39 versus 12 ( P < .06); cerebellum, 58 versus 20 ( P < .05); midbrain, 50 versus 18 ( P < .05); pons, 52 versus 22 ( P < .06); medulla, 53 versus 20 ( P < .05); and spinal cord, 31 versus 12 ( P < .05). DMVA produces greater regional cerebral blood flow than is produced during MAN after 15 minutes of ventricular fibrillation. DMVA is effective at maintaining regional cerebral blood flow after a prolonged cardiac arrest.