Bundled postconditioning therapies improve hemodynamics and neurologic recovery after 17 min of untreated cardiac arrest
Bundled postconditioning therapies improve hemodynamics and neurologic recovery after 17 min of untreated cardiac arrest
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DOI：
10.1016/j.resuscitation.2014.10.019
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发表时间：
2015-02-01
期刊：
影响因子：
6.5
通讯作者：
Yannopoulos, Demetris
中科院分区：
文献类型：
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作者：
Bartos, Jason A.;Matsuura, Timothy R.;Yannopoulos, Demetris
目的：缺血后处理和七氟醚可减轻室颤(VF)心脏骤停15分钟后心肌组织的再灌注损伤。在人类和动物模型中，泊洛沙姆188(P188)也被证明对再灌注损伤中的神经元和心脏组织有益。我们假设卡顿CPR、七氟醚和p188联合使用标准的高级生命支持可以改善长时间室颤停跳后复苏后的心脏和神经功能。方法：20头猪随机分为两组，每组12头，分别采用主动按压/减压(ACD)CPR+阻抗阈值装置(ITD)(n=8)和卡顿ACD CPR+ITD+七氟醚+p188(n=12)治疗。两组均按标准方案给予肾上腺素和复苏后低温治疗。对恢复自主循环(ROSC)的动物进行超声心动图、生物标志物和盲性神经学评估，并进行脑功能分类评分。结果：与对照组相比，束疗法改善了复苏过程中的血流动力学，减少了对肾上腺素的需求和反复除颤，减少了心脏损伤和终末器官功能障碍的生物标志物，增加了左心室射血分数。捆绑治疗还提高了ROSC的发生率(100%比50%)，避免主要不良事件的发生率(48h时50%比0%)，以及神经功能(42%有轻度或无神经功能缺陷，17%在48h达到正常功能)。结论：结合口吃ACD CPR、ITD、七氟醚和p188的捆绑治疗改善了未经治疗的猪心脏骤停17分钟后的心脏和神经功能。所有研究均获得明尼阿波利斯医学研究基金会机构动物护理委员会的批准(协议#12-11)。(C)2014爱思唯尔爱尔兰有限公司。保留所有权利。
Objective: Ischemic postconditioning (stutter CPR) and sevoflurane have been shown to mitigate the effects of reperfusion injury in cardiac tissue after 15 min of ventricular fibrillation (VF) cardiac arrest. Poloxamer 188 (P188) has also proven beneficial to neuronal and cardiac tissue during reperfusion injury in human and animal models. We hypothesized that the use of stutter CPR, sevoflurane, and P188 combined with standard advanced life support would improve post-resuscitation cardiac and neurologic function after prolonged VF arrest.Methods: Following 17 min of untreated VF, 20 pigs were randomized to Control treatment with active compression/decompression (ACD) CPR and impedance threshold device (ITD) (n = 8) or Bundle therapy with stutter ACD CPR + ITD + sevoflurane + P188 (n = 12). Epinephrine and post-resuscitation hypothermia were given in both groups per standard protocol. Animals that achieved return of spontaneous circulation (ROSC) were evaluated with echocardiography, biomarkers, and a blinded neurologic assessment with a cerebral performance category score.Results: Bundle therapy improved hemodynamics during resuscitation, reduced need for epinephrine and repeated defibrillation, reduced biomarkers of cardiac injury and end-organ dysfunction, and increased left ventricular ejection fraction compared to Controls. Bundle therapy also improved rates of ROSC (100% vs. 50%), freedom from major adverse events (50% vs. 0% at 48 h), and neurologic function (42% with mild or no neurologic deficit and 17% achieving normal function at 48 h).Conclusions: Bundle therapy with a combination of stutter ACD CPR, ITD, sevoflurane, and P188 improved cardiac and neurologic function after 17 min of untreated cardiac arrest in pigs.All studies were performed with approval from the Institutional Animal Care Committee of the Minneapolis Medical Research Foundation (protocol #12-11). (C) 2014 Elsevier Ireland Ltd. All rights reserved.