Tilting for perfusion: Head-up position during cardiopulmonary resuscitation improves brain flow in a porcine model of cardiac arrest
Tilting for perfusion: Head-up position during cardiopulmonary resuscitation improves brain flow in a porcine model of cardiac arrest
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DOI：
10.1016/j.resuscitation.2014.11.019
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发表时间：
2015-02-01
期刊：
影响因子：
6.5
通讯作者：
Lurie, Keith
中科院分区：
文献类型：
--
作者：
Debaty, Guillaume;Shin, Sang Do;Lurie, Keith
简介：心肺复苏 (CPR) 期间脑灌注受到损害。我们假设，与仰卧或低头倾斜 (HDT) 相比，在头仰倾斜 (HUT) 位置进行心肺复苏期间重力对静脉循环的有益影响将改善脑灌注。方法：对 22 只猪进行镇静、插管、麻醉、麻痹并放置在倾斜台上。未经治疗的心室颤动 (VF) 6 分钟后，使用名为 LUCAS (L) 的自动心肺复苏装置加阻抗阈值装置 (ITD) 对 14 只猪进行心肺复苏 3 分钟，然后在 0 度仰卧位进行 5 分钟 L-CPR + ITD，在 30 度 HUT 进行 5 分钟，然后在 30 度 HDT 进行 5 分钟。使用微球测量 8 头猪的器官血流量。在 0 度、20 度、30 度、40 度和 50 度 HUT 下对另外 8 头猪进行了 L-CPR + ITD。 结果：冠状动脉灌注压在 0 度时为 19 +/- 2 mmHg，而在 30 度 HUT 时为 30 +/- 3 (p < 0.001)，在 30 度 HDT 时为 10 +/- 3 (p < 0.001）。 0 度时脑灌注压为 19 垂直于 3，而 30 度 HUT 时脑灌注压为 35 垂直于 3 (p < 0.001)，30 度 HDT 时脑灌注压为 4 +/- 4 (p < 0.001)。 0 度时脑血流量为 0.19 +/- 0.04 ml min(-1) g(-1)，而 30 度时脑血流量为 0.27 +/- 0.04。 HUT (p = 0.01) 和 30 度时为 0.14 +/- 0.06。 HDT（p = 0.16）。干预措施之间的心脏血流量没有显着差异。 HUT 为 0、10、20、30、40 和 50 度时，ICP 值分别为 21 +/- 2、16 +/- 2、10 +/- 2、5 +/- 2、0 +/- 2、-5 +/- 2（p < 0.001），CerPP 线性增加（p = 0.001），CPP 保持恒定。结论： CPR、HDT 减少脑流量，而 HUT 显着降低 ICP 并改善脑灌注。需要进一步研究来探索这一新的复苏概念。 (C) 2014 Elsevier Ireland Ltd. 保留所有权利。
Introduction: Cerebral perfusion is compromised during cardiopulmonary resuscitation (CPR). We hypothesized that beneficial effects of gravity on the venous circulation during CPR performed in the head-up tilt (HUT) position would improve cerebral perfusion compared with supine or head-down tilt (HDT).Methods: Twenty-two pigs were sedated, intubated, anesthetized, paralyzed and placed on a tilt table. After 6 min of untreated ventricular fibrillation (VF) CPR was performed on 14 pigs for 3 min with an automated CPR device called LUCAS (L) plus an impedance threshold device (ITD), followed by 5 min of L-CPR + ITD at 0 degrees supine, 5 min at 30 degrees HUT, and then 5 min at 30 degrees HDT. Microspheres were used to measure organ blood flow in 8 pigs. L-CPR + ITD was performed on 8 additional pigs at 0 degrees, 20 degrees, 30 degrees, 40 degrees, and 50 degrees HUT.Results: Coronary perfusion pressure was 19 +/- 2 mmHg at 0 degrees vs. 30 +/- 3 at 30 degrees HUT (p < 0.001) and 10 +/- 3 at 30 degrees HDT (p < 0.001). Cerebral perfusion pressure was 19 perpendicular to 3 at 0 degrees vs. 35 perpendicular to 3 at 30 degrees HUT (p < 0.001) and 4 +/- 4 at 30 degrees HDT (p < 0.001). Brain-blood flow was 0.19 +/- 0.04 ml min(-1) g(-1) at 0 degrees vs. 0.27 +/- 0.04 at 30 degrees. HUT (p = 0.01) and 0.14 +/- 0.06 at 30 degrees. HDT (p = 0.16). Heart blood flow was not significantly different between interventions. With 0, 10, 20, 30, 40 and 50 degrees HUT, ICP values were 21 +/- 2, 16 +/- 2, 10 +/- 2, 5 +/- 2, 0 +/- 2, -5 +/- 2 respectively, (p < 0.001), CerPP increased linearly (p = 0.001), and CPP remained constant.Conclusion: During CPR, HDT decreased brain flow whereas HUT significantly lowered ICP and improved cerebral perfusion. Further studies are warranted to explore this new resuscitation concept. (C) 2014 Elsevier Ireland Ltd. All rights reserved.