A few weeks ago, we discussed REBOA, a cutting edge procedure to control hemorrhage. Let's go beyond cutting edge to the future of trauma and medical arrest care using a similar aortic catheter. This one allows you to administer blood and drugs to the proximal aorta.
Jim Manning, MD has been working on these issues for over two decades in his lab in North Carolina. This may very well be the future of CPR for medical and traumatic arrests.
Here are Dr. Manning's Disclosures: Inventor on patents for the Selective Aortic Arch Perfusion technology that are assigned to the University of North Carolina at Chapel Hill; Co-Founder of Resusitech, Inc., a medical device company developing invasive resuscitation technologies.
Selective Aortic Arch Perfusion
The following slide shows where SAAP may fit in with the other therapies for cardiac arrest:
And this one shows a possible progression during arrest:
Update: Want More?
Jim gave a lecture for GSA HEMS that is fantastic!
What do you think? Comment Below.
Now on to the Podcast…
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Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
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[…] “Prime Time!”, and as Weingart mentioned in his recent episode of the EMCRIT podcast: Podcast 123 – Selective Aortic Arch Perfusion (SAAP) with Jim Manning, Zack and I were at UNC Chapel Hill in Jim Manning’s lab doing several experiments in a pig […]
So when doing SAAP is the blood given through the catheter oxygenated? If so, how?
Yes! A good question and an important point to make clear. The blood (or other oxygen carrier) needs to be oxygenated prior to infusion via the SAAP catheter. SAAP involves infusion directly into the arterial system (aortic arch), so the lungs cannot be used to oxygenate the perfusate before it reaches the heart and brain. We have accomplished this in the laboratory using various oxygenators that are used for cardiopulmonary bypass or ECMO. Such oxygenators are now small enough that they are readily portable. Thanks! Jim
Hello Scott-
I was curious as to how blood continuing the circuit from the periphery is cycled through the body if the aorta is essentially cross-clamped (endovascularly speaking). How is venous blood pooling prevented when continuous transfusion is applied? Thanks!
Nick,
purpose of this is purely short term to perfuse heart and brain. Don’t need to worry about rest of body for this period of time. I think it was mentioned on the podcast that after a few units of blood, goal is to place venous drainage line. If the patient gets, ROSC, I would imagine dropping the balloon on the SAAP to allow partial VA ECMO while you are transitioning to art cannula.
[…] week on EMCrit, Scott Weingart gives us a glimpse into selective aortic arch perfusion: the bleeding edge of cardiac arrest research. […]
[…] topics were covered including sports cardiology, latest research in trauma resuscitation (including SAAP – wow), performance psychology, and ECMO in cardiac arrest. Educational pearls and […]
[…] Bob Bartlett, Amy Hackmann from USC, and Joe Dubose from Shock Trauma. Jim Manning showed us his SAAP catheter, and vendors were on hand to demonstrate specialized hardware. It was […]