Hydroxocobalamin and Epinephrine Both Improve Survival in a Swine Model of Cyanide-Induced Cardiac Arrest
Hydroxocobalamin and Epinephrine Both Improve Survival in a Swine Model of Cyanide-Induced Cardiac Arrest
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DOI：
10.1016/j.annemergmed.2012.02.002
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发表时间：
2012-10-01
影响因子：
6.2
通讯作者：
Little, Charles M.
中科院分区：
文献类型：
--
作者：
Bebarta, Vikhyat S.;Pitotti, Rebecca L.;Little, Charles M.
研究目的：在氰化物诱导的心脏骤停模型中，与肾上腺素和生理盐水对照组相比，羟钴胺是否能提高存活率。方法：45只猪(38~42 kg)气管插管，麻醉后插入中心静脉和动脉连续心血管监测导管。注射氰化钾直到发生心脏骤停，定义为平均动脉压低于30毫米汞。动物接受标准化的机械按压治疗，并被随机分配到3种静脉推注疗法中的一种：羟钴胺、肾上腺素或生理盐水(对照组)。所有动物在心脏骤停后被监测60分钟。在收缩压低于90毫米汞柱的自主循环恢复后，研究的所有分支都使用了额外的肾上腺素注射。每组15只动物的样本大小是根据80%的幂、0.5的存活率差异和0.05的阿尔法确定的。结果：3组患者的基线体重、停跳时间和停跳时氰化物剂量相似。两个治疗组的冠脉灌注压和胸部按压均大于15毫米汞柱，表明有足够的按压深度。对照组15只动物中0只(95%可信区间0%~25%)，羟钴胺组15只动物中11只存活(73%；95%可信区间48%~90%)，肾上腺素组15只动物中11只存活(73%；95%可信区间48%~90%)(P
Study objective: To determine whether hydroxocobalamin will improve survival compared with epinephrine and saline solution controls in a model of cyanide-induced cardiac arrest.Methods: Forty-five swine (38 to 42 kg) were tracheally intubated, anesthetized, and central venous and arterial continuous cardiovascular monitoring catheters were inserted. Potassium cyanide was infused until cardiac arrest developed, defined as mean arterial pressure less than 30 mm Hg. Animals were treated with standardized mechanical chest compressions and were randomly assigned to receive one of 3 intravenous bolus therapies: hydroxocobalamin, epinephrine, or saline solution (control). All animals were monitored for 60 minutes after cardiac arrest. Additional epinephrine infusions were used in all arms of the study after return of spontaneous circulation for systolic blood pressure less than 90 mm Hg. A sample size of 15 animals per group was determined according to a power of 80%, a survival difference of 0.5, and an alpha of 0.05. Repeated-measure ANOVA was used to determine statistically significant changes between groups over time.Results: Baseline weight, time to arrest, and cyanide dose at cardiac arrest were similar in the 3 groups. Coronary perfusion pressures with chest compressions were greater than 15 mm Hg in both treatment groups indicating sufficient compression depth. Zero of 15 (95% confidence interval [CI] 0% to 25%) animals in the control group, 11 of 15 (73%; 95% CI 48% to 90%) in the hydroxocobalamin group, and 11 of 15 (73%; 95% CI 48% to 90%) in the epinephrine group survived to the conclusion of the study (P