Enhanced perfusion during advanced life support improves survival with favorable neurologic function in a porcine model of refractory cardiac arrest.
Enhanced perfusion during advanced life support improves survival with favorable neurologic function in a porcine model of refractory cardiac arrest.
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DOI：
10.1097/ccm.0000000000000939
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发表时间：
2015-05
影响因子：
8.8
通讯作者：
Lurie K
中科院分区：
文献类型：
--
作者：
Debaty G;Metzger A;Rees J;McKnite S;Puertas L;Yannopoulos D;Lurie K
为了提高心脏骤停后神经功能良好的生存可能性，我们评估了一种新的先进的生命支持方法，使用主动按压-减压心肺复苏加胸内压力调节器。前瞻性动物研究。动物实验室。雌性农场猪（n = 25）（39 ± 3 kg）。方案A：在未经处理的室颤12分钟后，18只猪被随机分配到A组-3分钟的基本生命支持与标准心肺复苏、除颤，并且如果需要，2分钟的高级生命支持与标准心肺复苏;组B-3分钟的基本生命支持，标准心肺复苏，除颤，如果需要，2分钟的高级生命支持，包括主动按压-减压加胸内压力调节器; C组：基础生命支持3分钟，主动按压-减压心肺复苏加阻抗阈值装置，除颤，如果需要，2分钟的高级生命支持，主动按压-减压加胸内压力调节器。高级生命支持始终包括IV肾上腺素（0.05 μg/kg）。主要终点是24小时脑功能分类评分。方案B：7只猪在心室颤动前和心室颤动后6分钟分别用主动加压减压加阻抗阈值装置、主动加压减压加胸内压力调节器和主动加压减压加胸内压力调节器加肾上腺素连续治疗5分钟，测量心肌和脑血流量。方案A：A组6头猪中有1头存活24小时，而B和C组6头猪中有6头存活24小时（p = 0.002），脑功能分类评分分别为4.7 ± 0.8、1.7 ± 0.8和1.0 ± 0（p = 0.001）。方案B：主动加压减压加胸内压力调节器组脑血流量明显高于主动加压减压加阻抗阈值装置组（0.39 ± 0.23 vs 0.27 ± 0.14 mL/min/g; p = 0.03），而心肌灌注差异无统计学意义（0.65 ± 0.81 vs 0.42 ± 0.36 mL/min/g; p = 0.23）。与主动按压-减压加阻抗阈值装置相比，主动按压-减压加胸内压力调节器加肾上腺素的脑和心肌血流量显著增加（0.40 ± 0.22和0.84 ± 0.60 mL/min/g;两者p = 0.02）。先进的生命支持，积极的压缩-减压加胸内压力调节器显着改善脑灌注和24小时生存良好的神经功能。这些发现支持进一步评估这种新的人类先进生命支持方法。
To improve the likelihood for survival with favorable neurologic function after cardiac arrest, we assessed a new advanced life support approach using active compression-decompression cardiopulmonary resuscitation plus an intrathoracic pressure regulator. Prospective animal investigation. Animal laboratory. Female farm pigs (n = 25) (39 ± 3 kg). Protocol A: After 12 minutes of untreated ventricular fibrillation, 18 pigs were randomized to group A—3 minutes of basic life support with standard cardiopulmonary resuscitation, defibrillation, and if needed 2 minutes of advanced life support with standard cardiopulmonary resuscitation; group B—3 minutes of basic life support with standard cardiopulmonary resuscitation, defibrillation, and if needed 2 minutes of advanced life support with active compression-decompression plus intrathoracic pressure regulator; and group C—3 minutes of basic life support with active compression-decompression cardiopulmonary resuscitation plus an impedance threshold device, defibrillation, and if needed 2 minutes of advanced life support with active compression-decompression plus intrathoracic pressure regulator. Advanced life support always included IV epinephrine (0.05 μg/kg). The primary endpoint was the 24-hour Cerebral Performance Category score. Protocol B: Myocardial and cerebral blood flow were measured in seven pigs before ventricular fibrillation and then following 6 minutes of untreated ventricular fibrillation during sequential 5 minutes treatments with active compression-decompression plus impedance threshold device, active compression-decompression plus intrathoracic pressure regulator, and active compression-decompression plus intrathoracic pressure regulator plus epinephrine. Protocol A: One of six pigs survived for 24 hours in group A versus six of six in groups B and C (p = 0.002) and Cerebral Performance Category scores were 4.7 ± 0.8, 1.7 ± 0.8, and 1.0 ± 0, respectively (p = 0.001). Protocol B: Brain blood flow was significantly higher with active compression-decompression plus intrathoracic pressure regulator compared with active compression-decompression plus impedance threshold device (0.39 ± 0.23 vs 0.27 ± 0.14 mL/min/g; p = 0.03), whereas differences in myocardial perfusion were not statistically significant (0.65 ± 0.81 vs 0.42 ± 0.36 mL/min/g; p = 0.23). Brain and myocardial blood flow with active compression-decompression plus intrathoracic pressure regulator plus epinephrine were significantly increased versus active compression-decompression plus impedance threshold device (0.40 ± 0.22 and 0.84 ± 0.60 mL/min/g; p = 0.02 for both). Advanced life support with active compression-decompression plus intrathoracic pressure regulator significantly improved cerebral perfusion and 24-hour survival with favorable neurologic function. These findings support further evaluation of this new advanced life support methodology in humans.