Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest
Head and thorax elevation during active compression decompression cardiopulmonary resuscitation with an impedance threshold device improves cerebral perfusion in a swine model of prolonged cardiac arrest
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DOI：
10.1016/j.resuscitation.2017.07.033
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发表时间：
2017-12-01
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：
Moore, Johanna C.;Segal, Nicolas;Lurie, Keith G.
研究目的：由于大多数心肺复苏（CPR）的努力持续时间超过15分钟，本研究的目的是在猪心脏骤停模型中使用主动按压-减压（ACD）CPR和阻抗阈值装置（ITD），比较15分钟长时间CPR努力期间头向上（HUP）和仰卧（仰卧）体位之间的脑血流量。在麻醉的猪中诱导室颤（VF）。在8分钟未处理VF后，随后在仰卧位进行2分钟ACD-CPR + ITD，将猪随机分配至30度HUP或仰卧位进行18分钟连续ACD-CPR + ITD。结果：心肺复苏15分钟后，HUP组（n = 8）和HUP组（n = 10）的平均脑血流量（ml/min/g，平均值± SD）分别为0.42 ± 0.05和0.21 ± 0.04 μ g（p < 0.01）。HUP组在HUT后5、15、19（肾上腺素注射前）和20（肾上腺素注射后）分钟的颅内压和计算的脑灌注压也显著低于HUP组，而HUT后20分钟的脑灌注压则显著高于HUP组。这些阳性结果为继续进行心脏骤停患者ACD-CPR + ITD期间头胸抬高的临床评价提供了强有力的临床前支持。(C)2017由Elsevier爱尔兰有限公司出版。
Aim of the study: As most cardiopulmonary resuscitation (CPR) efforts last longer than 15 min, the aim of this study was to compare brain blood flow between the Head Up (HUP) and supine (SUP) body positions during a prolonged CPR effort of 15 min, using active compression-decompression (ACD) CPR and impedance threshold device (ITD) in a swine model of cardiac arrest.Methods: Ventricular fibrillation (VF) was induced in anesthetized pigs. After 8 min of untreated VF followed by 2 min of ACD-CPR + ITD in the SUP position, pigs were randomized to 18 min of continuous ACD-CPR + ITD in either a 30 degrees HUP or SUP position. Microspheres were injected before VF and then 5 and 15 min after start of CPR.Results: The mean blood flow (ml/min/g, mean +/- SD) to the brain after 15 min of CPR was 0.42 +/- 0.05 in the HUP group (n = 8) and 0.21 +/- 0.04 SUP (n = 10), respectively, (p < 0.01). The HUP group also had statistically significantly lower intracranial pressures and higher calculated cerebral perfusion pressures after 5, 15, 19 (before adrenaline) and 20 (after adrenaline) minutes of HUT versus SUP CPR.Conclusions: After prolonged ACD-CPR + ITD in the HUP position, brain blood flow was 2-fold higher versus the SUP position. These positive findings provide strong pre-clinical support to proceed with a clinical evaluation of elevation of the head and thorax during ACD-CPR + ITD in humans in cardiac arrest. (C) 2017 Published by Elsevier Ireland Ltd.