The Effect of Head Up Cardiopulmonary Resuscitation on Cerebral and Systemic Hemodynamics
The Effect of Head Up Cardiopulmonary Resuscitation on Cerebral and Systemic Hemodynamics
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DOI：
10.1016/j.resuscitation.2016.01.033
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发表时间：
2016-05-01
期刊：
影响因子：
6.5
通讯作者：
Lurie, Keith G.
中科院分区：
文献类型：
--
作者：
Ryu, Hyun Ho;Moore, Johanna C.;Lurie, Keith G.
目的：心肺复苏 (CPR) 期间的胸外按压会增加动脉和静脉压力，同时向大脑传送双向高压压缩波。我们假设这可能是有害的，并且可以通过在心肺复苏期间抬高头部来部分克服。测量：对雌性约克夏猪（n = 30）进行镇静、插管、麻醉，并将其放置在能够在心肺复苏期间将头部抬高 30 度（15 厘米）（HUP）和心脏 10 度（4 厘米）或保持仰卧（SUP）平坦位置的桌子上。经过 8 分钟未经治疗的心室颤动和 2 分钟 SUP CPR 后，猪被随机分配接受 HUP 或 SUP CPR 20 分钟以上。在 A 组中，猪在进行 2 分钟的自动化常规 (C) CPR 后被随机分配至 HUP (n = 7) 或 SUP (n = 7) C-CPR。 B 组中，猪在进行 2 分钟自动主动加压减压 (ACD) CPR 加阻抗阈值装置 (ITD) SUP CPR 后被随机分为 HUP (n = 8) 或 SUP (n = 8)。 结果：该研究的主要结果是组内 HUP 和 SUP 位置之间 CerPP (mmHg) 的差异。 CPR 22 分钟后，A 组中 HUP 中的 CerPP 为 6 +/- 3 mmHg，而 SUP 中为 -5 +/- 3 (p = 0.016)，B 组中为 51 +/- 8 与 20 +/- 5 (p = 0.006)。22 分钟后的冠状动脉灌注压为 HUP 6 +/- 2 与 SUP 3 +/- 2 (p = A 组中为 0.283），B 组中为 HUP 32 +/- 5 与 SUP 19 +/- 5（p = 0.074）。在 B 组中，6/8 头猪在两个位置都进行了复苏。 A 组中没有猪复苏。结论：C-CPR 和 ACD + ITD CPR 中的 HUP 位置显着改善了 CerPP。这种简单的操作有可能改善心脏骤停后的神经系统结果。 (C) 2016 Elsevier Ireland Ltd. 保留所有权利。
Aim: Chest compressions during cardiopulmonary resuscitation (CPR) increase arterial and venous pressures, delivering simultaneous bidirectional high-pressure compression waves to the brain. We hypothesized that this may be detrimental and could be partially overcome by elevation of the head during CPR.Measurements: Female Yorkshire farm pigs (n = 30) were sedated, intubated, anesthetized, and placed on a table able to elevate the head 30 degrees (15 cm) (HUP) and the heart 10 degrees (4 cm) or remain in the supine (SUP) flat position during CPR. After 8 minutes of untreated ventricular fibrillation and 2 minutes of SUP CPR, pigs were randomized to HUP or SUP CPR for 20 more minutes. In Group A, pigs were randomized after 2 minutes of flat automated conventional (C) CPR to HUP (n = 7) or SUP (n = 7) C-CPR. In Group B, pigs were randomized after 2 minutes of automated active compression decompression (ACD) CPR plus an impedance threshold device (ITD) SUP CPR to either HUP (n = 8) or SUP (n = 8).Results: The primary outcome of the study was difference in CerPP (mmHg) between the HUP and SUP positions within groups. After 22 minutes of CPR, CerPP was 6 +/- 3 mmHg in the HUP versus -5 +/- 3 in the SUP (p = 0.016) in Group A, and 51 +/- 8 versus 20 +/- 5 (p = 0.006) in Group B. Coronary perfusion pressures after 22 minutes were HUP 6 +/- 2 vs SUP 3 +/- 2 (p = 0.283) in Group A and HUP 32 +/- 5 vs SUP 19 +/- 5, (p = 0.074) in Group B. In Group B, 6/8 pigs were resuscitated in both positions. No pigs were resuscitated in Group A.Conclusions: The HUP position in both C-CPR and ACD + ITD CPR significantly improved CerPP. This simple maneuver has the potential to improve neurological outcomes after cardiac arrest. (C) 2016 Elsevier Ireland Ltd. All rights reserved.