Effect of controlled sequential elevation timing of the head and thorax during cardiopulmonary resuscitation on cerebral perfusion pressures in a porcine model of cardiac arrest.
Effect of controlled sequential elevation timing of the head and thorax during cardiopulmonary resuscitation on cerebral perfusion pressures in a porcine model of cardiac arrest.
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DOI：
10.1016/j.resuscitation.2019.12.011
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发表时间：
2020-04
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：
Rojas-Salvador, Carolina;Moore, Johanna C.;Salverda, Bayert;Lick, Michael;Debaty, Guillaume;Lurie, Keith G.
关键词：
在使用阻抗阈值装置（ITD）的主动按压-减压（ACD）CPR期间，头部和胸部（CSE）的受控顺序升高增加了脑（CerPP）和冠状动脉（CorPP）灌注压。最佳CSE未知。在未处理的VF 8分钟后，将40 kg麻醉的雌性猪定位在定制的头胸抬高装置（CED）上。在2分钟的自动ACD+ITD-16 CPR "启动系统“后，12头猪被随机分配到CSE，在4分钟或10分钟内达到最高CED位置。主要结局是7分钟CPR后的CerPP。其次，以非随机顺序对24秒（无预充步骤）和2分钟CSE时间进行了类似测试（n=6组）。数值表示为平均值± SD。CPR 7分钟后，4分钟CSE组与10分钟CSE组的CerPP显著较高（分别为53 ± 14.4与38.5 ± 3.6 mmHg，p=0.03），而CorPP有较高的趋势。4分钟CSE组比10分钟组更快达到基线的50%（50% BL）CerPP（2.5 ± 1.2 vs 6 ± 3.1分钟，p=0.03）。2分钟和4分钟CSE组的CerPP值显著高于24秒组。对于CSE，所有组的CerPP和CorPP均随时间推移而增加。通过优化受控的顺序升高时间，CerPP值在不到2.5分钟内达到基线的50%，在CPR 7分钟后达到基线的>80%。这种新的CPR方法快速恢复CerPP接近正常值非侵入性和无血管加压药。
Controlled sequential elevation of the head and thorax (CSE) during active compression-decompression (ACD) CPR with an impedance threshold device (ITD) augments cerebral (CerPP) and coronary (CorPP) perfusion pressures. The optimal CSE is unknown. After 8 min of untreated VF, 40 kg anesthetized female pigs were positioned on a customized head and thorax elevation device (CED). After 2 min of automated ACD+ITD-16 CPR to ‘prime the system’, 12 pigs were randomized to CSE to the highest CED position over 4-min or 10-min. The primary outcome was CerPP after 7 minutes of CPR. Secondarily, 24-sec (without a priming step) and 2-min CSE times were similarly tested (n=6 group) in a non-randomized order. Values expressed as mean ± SD. After 7 min of CPR, CerPPs were significantly higher in the 4-min vs 10-min CSE groups (53 ± 14.4 vs 38.5 ± 3.6 mmHg respectively, p=0.03) whereas CorPP trended higher. The 4-min CSE group achieved 50% of baseline (50% BL) CerPP faster than the 10-min group (2.5 ± 1.2 vs 6 ± 3.1 minutes, p=0.03). CerPP values in the 2-min and 4-min CSE groups were significantly higher than in the 24-sec group. With CSE, CerPPs and CorPPs increased over time in all groups. By optimizing controlled sequential elevation timing, CerPP values achieved 50% of baseline within less than 2.5 minutes and >80% of baseline after 7 minutes of CPR. This novel CPR approach rapidly restored CerPPs to near normal values non-invasively and without vasopressors.
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