PREDICTIVE INDEXES OF SUCCESSFUL CARDIAC RESUSCITATION AFTER PROLONGED ARREST AND EXPERIMENTAL CARDIOPULMONARY RESUSCITATION
PREDICTIVE INDEXES OF SUCCESSFUL CARDIAC RESUSCITATION AFTER PROLONGED ARREST AND EXPERIMENTAL CARDIOPULMONARY RESUSCITATION
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DOI：
10.1016/s0196-0644(85)80774-5
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发表时间：
1985-01-01
影响因子：
6.2
通讯作者：
ALFERNESS, C
中科院分区：
文献类型：
--
作者：
NIEMANN, JT;CRILEY, JM;ALFERNESS, C
为了确定临床上可进行的血流动力学和血气测量对于预测长期心室颤动 (VF) 和人工心肺支持后的反休克结果是否有价值，使用 2 种随机分配的闭胸技术对 14 只狗在 30 分钟的 VF 期间进行了研究。 7 只狗接受了常规 CPR（心肺复苏）：另外 7 只用气动胸背心和腹部绑带支撑，与气道同步充气。以 5 分钟的间隔测量升主动脉 (Ao)、右心房 (RA) 和瞬时冠状动脉灌注压 (Ao-RA)。在 10、20、25 和 30 分钟时分析 Ao 和 RA 血样的 PO2 [O2 分压]、PCO2 和 pH 值。 25 分钟后，静脉注射 1 mg 肾上腺素，5 分钟后尝试除颤。如果不成功，则继续重复电击、常规药物治疗和人工支持。如果在另外 30 分钟内没有出现灌注自发心律，则实验终止。六只动物在 1 次或多次反电击后出现灌注心律（第 1 组）； 8 名患者在重复电击和额外 30 分钟的复苏努力后未能形成灌注节律（第 2 组）。五只第 1 组狗接受了背心/粘合剂人工支撑。当对研究期间的测量值进行平均时，发现与第 2 组相比，第 1 组的 Ao 舒张末期压力 (AoEDP) 和峰值舒张期冠状动脉灌注压 (CPP) 显着更高（23 .+-. 6 对比 14 .+-. 8 mm Hg，P < .05；22 .+-. 6 对比 5 .+-. 10 mm Hg， P < .01，分别）。尽管 AoEDP 和 CPP 之间存在显着相关性 (r = .73，P < .001)，但 AoEDP 高估了 10 只狗的 CPP，低估了 4 只狗的 CPP。CPP 在确定除颤结果方面的预测价值为 100%，而 AoEDP 的预测价值是可变的。动脉和静脉 (RA) PO2 和 PCO2 值在各组之间没有显着差异，且预测价值有限。尽管动脉和 RA pH 值之间存在显着但预测性较差的相关性 (r = .49, P < .001)，但静脉 pH 值与主动脉收缩压的预测值产生了反休克结果的预测指数（可比预测值 0.67 至 0.71；阴性预测值 0.86-1.00）。选定的临床可用的血流动力学和血气测量可以预测犬模型中长时间心肺复苏后的除颤结果。
To determine it clinically accessible hemodynamic and blood gas measurements are of value in predicting outcome of countershock after prolonged ventricular fibrillation (VF) and artificial cardiopulmonary support, 14 dogs were studied during 30 min of VF using 2 randomly assigned closed-chest techniques. Seven dogs underwent conventional CPR [cardiopulmonary resuscitation]: the other 7 were supported with a pneumatic thoracic vest and abdominal binder, which were inflated synchronously with the airway. Ascending aortic (Ao), right atrial (RA) and instantaneous coronary perfusion pressures (Ao-RA) were measured at 5-min intervals. Ao and RA blood samples were analyzed at 10, 20, 25 and 30 min for PO2 [partial pressure of O2], PCO2, and pH. After 25 min, 1 mg epinephrine was given i.v., and 5 min later defibrillation was attempted. If unsuccessful, repeated countershocks, conventional pharmacologic therapy, and artificial support were continued. If a perfusing spontaneous cardiac rhythm did not result within an additional 30 min, the experiment was terminated. Six animals developed a perfusing cardiac rhythm after 1 or more countershocks (group 1); 8 failed to develop a perfusing rhythm after repeated countershocks and an additional 30 min of resuscitative effort (group 2). Five group 1 dogs received vest/binder artificial support. When measured values were averaged over the study period, Group 1 was found to have a significantly greater Ao end-diastolic pressure (AoEDP) and peak diastolic coronary perfusion pressure (CPP) when compared to group 2 (23 .+-. 6 vs. 14 .+-. 8 mm Hg, P < .05; and 22 .+-. 6 vs. 5 .+-. 10 mm Hg, P < .01, respectively). Although a significant correlation was demonstrated between AoEDP and CPP (r = .73, P < .001), AoEDP overestimated CPP in 10 dogs and underestimated CPP in 4. The predictive value of CPP in determining defibrillation outcome was 100%, while that of AoEDP was variable. Arterial and venous (RA) PO2 and PCO2 values were not significantly different between groups, and they were of limited predictive value. Although a significant but poorly predictive correlation was demonstrated between arterial and RA pH values (r = .49, P < .001), venous pH yielded predictive indices of countershock outcome (comparable predictive value 0.67 to 0.71; negative predictive value, 0.86-1.00) to those of systolic aortic pressure. Selected clinically accessible hemodynamic and blood gas measurements can be predictive of defibrillation outcome after prolonged CPR in the canine model.