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Novel therapy with specially developed small "heart-lung machine" shows significantly better survival and good neurological regeneration / Individual cases successfully treated even after 1-2 hours of resuscitation

Around 50,000 people suffer a sudden cardiac arrest in Germany every year. If it happens outside a hospital, just one in ten survives - often with severe brain damage. With a new treatment method developed at the Medical Center - University of Freiburg, more than three times as many people can be saved in such cases. In addition, those affected often suffer little or no neurological damage. This has now been shown by physicians and researchers from the Medical Center - University of Freiburg together with colleagues from Germany, Austria and the Netherlands in a clinical, multicenter study involving 69 patients in the Journal of Clinical Medicine, which was published on December 21, 2023.

"After decades of research, we have achieved a breakthrough in emergency medicine with the CARL therapy we developed and the new heart-lung machine," says study leader Prof. Dr. Friedhelm Beyersdorf, former Medical Director of the Department of Cardiovascular Surgery at the Medical Center - University of Freiburg. CARL stands for Controlled Automated Reperfusion of the whoLe Body.

Until now, there was little hope of survival ten minutes after a cardiac arrest. "With the procedure we have developed, we are significantly extending the time span and improving the recovery of those affected," says lead author of the study Prof. Dr. Georg Trummer, senior physician at the Department of Cardiovascular Surgery at the Medical Center - University of Freiburg. In the first applications of the new procedure, people who had been in cardiac arrest for more than 60 minutes survived without permanent brain damage. Regardless of this, part of the concept is to treat affected patients as quickly as possible within 30-45 minutes of sudden cardiac arrest using this new procedure.

42 percent of all patients survive

Despite conventional cardiopulmonary resuscitation (CCPR), only 6 - 26 percent of patients survive a cardiac arrest. The Freiburg study now shows an overall survival rate of 42.0 percent on discharge from hospital. A favorable neurological outcome was found in 79.3 percent of survivors after 90 days. Patients with in-hospital cardiac arrest had a particularly high survival rate of 51.7 percent. For out-of-hospital cardiac arrest, the survival rate was 35 percent. If treatment was started outside the hospital, 57.1 percent of those affected survived. In the study, 69 patients aged between 21 and 86 were treated with the new procedure. The study was conducted in seven specialized heart centers.

CARL - For the first time, resuscitation therapy is possible in all its complexity

The Freiburg researchers have named their therapy concept CARL. "To our knowledge, CARL is the first device that has been specially developed for resuscitation and can, among other things, take over the patient's complete cardiopulmonary function. Above all, however, it is the only device in the world that makes it possible to treat the damage caused by cardiac arrest and the associated lack of oxygen. This is possible because we can immediately measure and control all the important parameters, such as blood values, that are necessary for successful resuscitation," says Prof. Dr. Christoph Benk, Head of Cardiotechnology at the Department of Cardiovascular Surgery at the Medical Center - University of Freiburg.

A unique double pump control system enables the necessary high pulsatile blood flow and achieves a high blood pressure. The oxygen level can be precisely controlled and the patient's body can be cooled down quickly and safely using a mobile cooling unit. "The size and weight of the device is designed so that it fits in the ambulance and can be carried directly to the patient," explains Benk.

Original title of the publication: Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study
DOI: 10.3390/jcm13010056
Link to the study (open access): www.mdpi.com/2077-0383/13/1/56

Further information:

Video:Summary of the underlying therapeutic principle
Video:Report on the clinical application of CARL therapy
Video:Technical aspects of the CARL system
Published case study:https://pubmed.ncbi.nlm.nih.gov/28693585/

Treated patients are available for discussion if interested.

Caption: The specially developed CARL device can measure and control important parameters during resuscitation. This doubles the chance of survival after a cardiac arrest, as a recent study by the Medical Center - University of Freiburg shows.
Image source: Medical Center - University of Freiburg / Britt Schilling