Reperfusion injury protection during Basic Life Support improves circulation and survival outcomes in a porcine model of prolonged cardiac arrest
Reperfusion injury protection during Basic Life Support improves circulation and survival outcomes in a porcine model of prolonged cardiac arrest
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DOI：
10.1016/j.resuscitation.2016.05.008
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发表时间：
2016-08-01
期刊：
影响因子：
6.5
通讯作者：
Yannopoulos, Demetris
中科院分区：
文献类型：
--
作者：
Debaty, Guillaume;Lurie, Keith;Yannopoulos, Demetris
目的：当除颤前使用肾上腺素 (epi) 时，在心肺复苏 (CPR) 开始时使用三个有意暂停的缺血后处理 (PC) 可改善猪心脏骤停后的结果。我们假设在没有肾上腺素的情况下在基本生命支持 (BLS) 期间进行的 PC 会减少再灌注损伤并增强 24 小时功能恢复。设计：前瞻性动物研究。设置：动物实验室受试者：母猪（n = 46, 39 +/- 1 kg）。干预措施：方案 A：心室颤动 (VF) 12 分钟后，28 头猪被随机分为四组：(A) 标准组CPR (SCPR)、(B) 使用阻抗阈值装置进行主动压缩-减压 CPR (ACD-ITD)、(C) SCPR + PC (SCPR + PC) 和 (D) ACD-ITD CPR + PC。方案 B：VF 15 分钟后，18 头猪被随机分配至 ACD-ITD CPR 或 ACD-ITD + PC。方案 A 中的 BLS 持续时间为 2.75 分钟，方案 B 中的 BLS 持续时间为 5 分钟。BLS 后，最多进行 3 次电击。在没有恢复自主循环（ROSC）的情况下，恢复心肺复苏并进行心肺复苏（0.5 mg）和除颤。主要终点是无重大不良事件的生存期。还测量了血流动力学参数和左心室射血分数（LVEF）。数据以平均值 +/- SEM 表示。测量和主要结果：方案 A：ACD-ITD + PC（D 组）与其他三组相比，BLS 3 分钟后改善了冠状动脉灌注压（A、B、C、D 组分别为 28 +/- 6、35 +/- 7、23 +/- 5 和 47 +/- 7，p = 0.05）。组间 24 小时生存率没有显着差异。方案 B：ROSC 后 4 小时的 LVEF 与单独使用 ACD-ITD 相比，ACD-ITD + PC 显着更高（52.5 +/- 3% 对比 37.5 +/- 6.6%，p = 0.045）。与单独使用 ACD-ITD 相比，使用 ACD-ITD + PC 的存活率显着更高 (p = 0.027)。 结论：使用 ACD-ITD + PC 的 BLS 可减少猪复苏后心功能不全，并改善猪长期未经治疗的心室颤动后的功能恢复。 (C) 2016 Elsevier Ireland Ltd. 保留所有权利。
Objective: Ischemic postconditioning (PC) using three intentional pauses at the start of cardiopulmonary resuscitation (CPR) improves outcomes after cardiac arrest in pigs when epinephrine (epi) is used before defibrillation. We hypothesized PC, performed during basic life support (BLS) in the absence of epinephrine, would reduce reperfusion injury and enhance 24 h functional recovery.Design: Prospective animal investigation.Setting: Animal laboratorySubjects: Female farm pigs (n = 46, 39 +/- 1 kg).Interventions: Protocol A: After 12 min of ventricular fibrillation (VF), 28 pigs were randomized to four groups: (A) Standard CPR (SCPR), (B) active compression-decompression CPR with an impedance threshold device (ACD-ITD), (C) SCPR + PC (SCPR + PC) and (D) ACD-ITD CPR + PC. Protocol B: After 15 min of VF, 18 pigs were randomized to ACD-ITD CPR or ACD-ITD + PC. The BLS duration was 2.75 min in Protocol A and 5 min in Protocol B. Following BLS, up to three shocks were delivered. Without return of spontaneous circulation (ROSC), CPR was resumed and epi (0.5 mg) and defibrillation delivered. The primary end point was survival without major adverse events. Hemodynamic parameters and left ventricular ejection fraction (LVEF) were also measured. Data are presented as mean +/- SEM.Measurements and Main Results: Protocol A: ACD-ITD + PC ( group D) improved coronary perfusion pressure after 3 min of BLS versus the three other groups (28 +/- 6, 35 +/- 7, 23 +/- 5 and 47 +/- 7 for groups A, B, C, D respectively, p = 0.05). There were no significant differences in 24 h survival between groups.Protocol B: LVEF 4 h post ROSC was significantly higher with ACD-ITD + PC vs ACD-ITD alone (52.5 +/- 3% vs. 37.5 +/- 6.6%, p = 0.045). Survival rates were significantly higher with ACD-ITD + PC vs. ACD-ITD alone (p = 0.027).Conclusions: BLS using ACD-ITD + PC reduced post resuscitation cardiac dysfunction and improved functional recovery after prolonged untreated VF in pigs. (C) 2016 Elsevier Ireland Ltd. All rights reserved.