Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest
Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest
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DOI：
10.1016/j.resuscitation.2004.10.009
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发表时间：
2005-03-01
期刊：
影响因子：
6.5
通讯作者：
Lurie, KG
中科院分区：
文献类型：
--
作者：
Yannopoulos, D;McKnite, S;Lurie, KG
最近的数据表明，在心肺复苏减压阶段产生的胸内负压可改善血流动力学、器官灌注和生存率。假设：标准CPR减压阶段胸壁不完全后坐力增加胸内压和右房压，阻碍静脉回流，降低压迫引起的主动脉压，导致平均动脉压、冠状动脉和脑灌注压降低。方法：9头心室颤动（VF）持续6 min的猪，采用自动压缩/减压装置，压缩率为100 min(-1)，深度为前后径的25%，压缩通气比为15:2,100%减压（标准CPR） 3 min。然后在心肺复苏术1分钟内将压力降至完全减压的75%，然后再恢复1分钟心肺复苏术至100%完全减压。冠状动脉灌注压（CPP）计算为舒张压(主动脉压（Ao)-右心房压（RA））。脑灌注压（CerPP）采用多种方法计算：(1)主动脉压与颅内压（ICP）波形之间的正面积（mmHg s），(2)收缩期和舒张期主动脉压与颅内压（mmHg）的重合差，(3)CerPP = MAP - ICP。采用方差分析进行统计分析，所有值均以均数S.E.M.表示。在0.05的α显著性水平下，研究的功率为> 0.90。结果：100% ~ 75% ~ 100%胸壁完全后坐力进行CPR时，CPP分别为23.3 +/- 1.9、15.1 +/- 1.6、16.6 +/- 1.9,p = 0.003；CerPP是:(1)面积:313.8 + / - 104,89.2 + / - 39,170.5 + / - 42.9,p = 0.03,(2)收缩期主动脉-颅内压的区别:22.8 + / - 3.6,16.5 + / - 4,23.7 + / - 4.5,p = n,和舒张压的区别:5.7 + / - 3,-2.4 + / - 2.4,3.2 + / - 2.5,p = 0.04(3)的意思是:14.3 + / - 3,7 + / - 2.9,12.4 + / - 2.9,p 0.03,舒张期主动脉压力为28.1 + / - 2.5,20.7 + / - 1.9,20.9 + / - 2.1,p = 0.0125;减压时ICP分别为22.8 +/- 1.7、23 +/- 1.5、19.7 +/- 1.7,p = ns；平均ICP分别为37.1 +/- 2.3、35.5 +/- 2.2、35.2 +/- 2.4,p = ns；RA舒张压4.8 +/- 1.3,5.6 +/- 1.2,4.3 +/- 1.2 p = 0.1；地图是52 + / - 2.9,43.3 + / - 3,48.3 + / - 2.9,p = 0.04;减压气管内压力，-0.7 +/- 0.1,-0.3 +/- 0.1,-0.75 +/- 0。1, p = 0.045。结论：心肺复苏减压阶段胸壁不完全后坐力增加气管内压力，阻碍静脉回流，降低平均动脉压、冠状动脉和脑灌注压。2004爱思唯尔爱尔兰有限公司版权所有。
Introduction: Recent data suggest that generation of negative intrathoracic pressure during the decompression phase of CPR improves hemodynamics, organ perfusion and survival.Hypothesis: Incomplete chest wall recoil during the decompression phase of standard CPR increases intrathoracic pressure and right atrial pressure, impedes venous return, decreases compression-induced aortic pressures and results in a decrease of mean arterial pressure, coronary and cerebral perfusion pressure.Methods: Nine pigs in ventricular fibrillation (VF) for 6 min, were treated with an automated compression/decompression device with a compression rate of 100 min(-1), a depth of 25% of the anterior-posterior diameter, and a compression to ventilation ratio of 15:2 with 100% decompression (standard CPR) for 3 min. Compression was then reduced to 75% of complete decompression for I min of CPR and then restored for another 1 min of CPR to 100% full decompression. Coronary perfusion pressure (CPP) was calculated as the diastolic (aortic (Ao)-right atrial (RA) pressure). Cerebral perfusion pressure (CerPP) was calculated multiple ways: (1) the positive area (in mmHg s) between aortic pressure and intracranial pressure (ICP) waveforms, (2) the coincident difference in systolic and diastolic aortic and intracranial pressures (mmHg), and (3) CerPP = MAP - ICP. ANOVA was used for statistical analysis and all values were expressed as mean S.E.M. The power of the study for an alpha level of significance set at 0.05 was > 0.90.Results: With CPR performed with 100%-75%-100% of complete chest wall recoil, respectively, the CPP was 23.3 +/- 1.9, 15.1 +/- 1.6, 16.6 +/- 1.9, p = 0.003; CerPP was: (1) area: 313.8 +/- 104, 89.2 +/- 39, 170.5 +/- 42.9, p = 0.03, (2) systolic aortic minus intracranial pressure difference: 22.8 +/- 3.6, 16.5 +/- 4, 23.7 +/- 4.5, p = n.s., and diastolic pressure difference: 5.7 +/- 3, -2.4 +/- 2.4, 3.2 +/- 2.5, p = 0.04 and (3) mean: 14.3 +/- 3, 7 +/- 2.9, 12.4 +/- 2.9, p 0.03, diastolic aortic pressure was 28.1 +/- 2.5, 20.7 +/- 1.9, 20.9 +/- 2.1, p = 0.0125; ICP during decompression was 22.8 +/- 1.7, 23 +/- 1.5, 19.7 +/- 1.7, p = n.s. and mean ICP was 37.1 +/- 2.3, 35.5 +/- 2.2, 35.2 +/- 2.4, p = n.s.; RA diastolic pressure 4.8 +/- 1.3, 5.6 +/- 1.2, 4.3 +/- 1.2 p = 0.1; MAP was 52 +/- 2.9, 43.3 +/- 3, 48.3 +/- 2.9, p = 0.04; decompression endotracheal pressure, -0.7 +/- 0.1, -0.3 +/- 0.1, -0.75 +/- 0. 1, p = 0.045.Conclusions: Incomplete chest wall recoil during the decompression phase of CPR increases endotracheal pressure, impedes venous return and decreases mean arterial pressure, and coronary and cerebral perfusion pressures. (c) 2004 Elsevier Ireland Ltd. All rights reserved.