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We hypothesized that the addition of inhaled nitric oxide (iNO) during iCPR might prove synergistic, leading to improved myocardial performance due to lowering of right ventricular (RV) afterload, left ventricular (LV) preload, and myocardial energetics. This study aimed to characterize the changes in LV and RV function and global myocardial work indices (GWI) following iCPR, both with and without iNO, using 2-D transesophageal echocardiography (TEE) and GWI evaluation as a novel non-invasive measurement.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In 10 pigs, iCPR was initiated following electrically-induced CA and 10\u00a0min of untreated ventricular fibrillation (VF). Pigs were randomized to either 20\u00a0ppm (<jats:italic>20\u00a0ppm<\/jats:italic>, n\u2009=\u20095) or 0\u00a0ppm (<jats:italic>0\u00a0ppm<\/jats:italic>, n\u2009=\u20095) of iNO in addition to therapeutic hypothermia for 5\u00a0h following ROSC. All animals received TEE at five pre-specified time-points and invasive hemodynamic monitoring.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>LV end-diastolic volume (LVEDV) increased significantly in both groups following CA. iCPR alone led to significant LV unloading at 5\u00a0h post-ROSC with LVEDV values reaching baseline values in both groups (<jats:italic>20\u00a0ppm:<\/jats:italic> 68.2\u2009\u00b1\u20092.7 vs. 70.8\u2009\u00b1\u20096.1\u00a0mL, <jats:italic>p<\/jats:italic>\u2009=\u20090.486; <jats:italic>0\u00a0ppm<\/jats:italic>: 70.8\u2009\u00b1\u20091.3 vs. 72.3\u2009\u00b1\u20094.2\u00a0mL, <jats:italic>p<\/jats:italic>\u2009=\u20090.813, respectively). LV global longitudinal strain (GLS) increased in both groups following CA. LV-GLS recovered significantly better in the 20\u00a0ppm group at 5\u00a0h post-ROSC (<jats:italic>20\u00a0ppm<\/jats:italic>: \u2212\u200918\u2009\u00b1\u20093% vs. <jats:italic>0\u00a0ppm<\/jats:italic>: \u2212\u200913\u2009\u00b1\u20092%, <jats:italic>p<\/jats:italic>\u2009=\u20090.025). LV-GWI decreased in both groups after CA with no difference between the groups. Within <jats:italic>0\u00a0ppm<\/jats:italic> group, LV-GWI decreased significantly at 5\u00a0h post-ROSC compared to baseline (1,125\u2009\u00b1\u2009214 vs. 1,835\u2009\u00b1\u2009305\u00a0mmHg%, <jats:italic>p<\/jats:italic>\u2009=\u20090.011). RV-GWI was higher in the <jats:italic>20\u00a0ppm<\/jats:italic> group at 3\u00a0h and 5\u00a0h post-ROSC (<jats:italic>20\u00a0ppm<\/jats:italic>: 189\u2009\u00b1\u200943 vs. <jats:italic>0\u00a0ppm<\/jats:italic>: 108\u2009\u00b1\u200922\u00a0mmHg%, <jats:italic>p<\/jats:italic>\u2009=\u20090.049 and <jats:italic>20\u00a0ppm<\/jats:italic>: 261\u2009\u00b1\u200954 vs. <jats:italic>0\u00a0ppm<\/jats:italic>: 152\u2009\u00b1\u200942\u00a0mmHg%, <jats:italic>p<\/jats:italic>\u2009=\u20090.041). The blood flow calculated by the Impella controller following iCPR initiation correlated well with the pulsed-wave Doppler (PWD) derived pulmonary flow (PWD vs. controller: 1.8\u2009\u00b1\u20090.2 vs. 1.9\u2009\u00b1\u20090.2L\/min, <jats:italic>r<\/jats:italic>\u2009=\u20090.85, <jats:italic>p<\/jats:italic>\u2009=\u20090.012).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>iCPR after CA provided sufficient unloading and preservation of the LV systolic function by improving LV-GWI recovery. The addition of iNO to iCPR enabled better preservation of the RV-function as determined by better RV-GWI. Additionally, Impella-derived flow provided an accurate measure of total flow during iCPR.<\/jats:p>\n                \n              <\/jats:sec>","DOI":"10.1186\/s12872-021-01992-w","type":"journal-article","created":{"date-parts":[[2021,4,17]],"date-time":"2021-04-17T09:03:03Z","timestamp":1618650183000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Inhaled nitric oxide preserves ventricular function during resuscitation using a percutaneous mechanical circulatory support device in a porcine cardiac arrest model: an echocardiographic myocardial work analysis"],"prefix":"10.1186","volume":"21","author":[{"given":"Christoph","family":"Nix","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2243-8743","authenticated-orcid":false,"given":"Rashad","family":"Zayat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Ebeling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Goetzenich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uma","family":"Chandrasekaran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rolf","family":"Rossaint","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nima","family":"Hatam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Derwall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,17]]},"reference":[{"issue":"1","key":"1992_CR1","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1186\/s13054-015-0864-2","volume":"19","author":"M Derwall","year":"2015","unstructured":"Derwall M, Br\u00fccken A, Bleilevens C, Ebeling A, F\u00f6hr P, Rossaint R, Kern KB, Nix C, Fries M. 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Written informed consent was obtained from the institute for Laboratory Animal Research, University Hospital RWTH Aachen, Germany to use the animals in our study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"AG and CN are full-time employee of Abiomed Europe GmbH, Germany. UM is a full-time employee Inc., USA. All other authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"189"}}