Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest.
Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest.
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DOI：
10.1097/ccm.0b013e318298ad6b
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发表时间：
2013-12
影响因子：
8.8
通讯作者：
Berg RA
中科院分区：
文献类型：
--
作者：
Friess SH;Sutton RM;Bhalala U;Maltese MR;Naim MY;Bratinov G;Weiland TR 3rd;Garuccio M;Nadkarni VM;Becker LB;Berg RA
在心肺复苏(CPR)中，足够的冠脉灌注压(CPP)是建立自主循环恢复的关键。目前的美国心脏协会(AHA)指南建议对心脏骤停患者进行标准化的肾上腺素间隔给药。本研究的目的是在猪心脏骤停模型中比较使用血流动力学定向复苏策略和胸腔按压深度定向CPR的短期存活率。随机干预研究临床前动物实验室24头3月龄雌性猪在室颤发生7分钟后，随机接受三种复苏策略之一：1)血流动力学定向护理(CPP-20)：胸部按压，深度滴定至目标收缩压100 mm，滴定血管加压剂以维持CPP>；20 mm；2)深度33 mm(D33)：在标准AHA肾上腺素剂量下，目标CC深度33 mm；或3)深度51 mm(D51)：目标CC深度51 mm，标准HA肾上腺素剂量。所有动物在首次休克前均在视听反馈引导下进行人工心肺复苏10分钟。CPP-20组45分钟存活率(8/8)高于D33组(1/8)或D51组(3/8)；p=0.002。CPP-20组的冠脉灌注压高于D33组(p=0.004)和D51组(p=0.006)，存活组高于死亡组(p<；0.01)。肾上腺素总剂量和除颤尝试没有区别。与按压深度引导至33 mm或51 mm和标准AHA血管升压剂剂量相比，在CPR 10分钟内以CPPS>；20 mm为靶点的血流动力学定向复苏可提高VF心脏骤停患者的短期存活率。
During cardiopulmonary resuscitation (CPR), adequate coronary perfusion pressure (CPP) is essential for establishing return of spontaneous circulation. Current American Heart Association (AHA) guidelines recommend standardized interval administration of epinephrine for patients in cardiac arrest. The objective of this study was to compare short-term survival using a hemodynamic directed resuscitation strategy versus chest compression depth directed CPR in a porcine model of cardiac arrest. Randomized interventional study Preclinical animal laboratory Twenty four female 3-month old swine After 7 minutes of ventricular fibrillation, pigs were randomized to receive one of three resuscitation strategies: 1) Hemodynamic Directed Care (CPP-20): chest compressions (CCs) with depth titrated to a target systolic blood pressure of 100 mmHg and titration of vasopressors to maintain CPP > 20 mmHg; 2) Depth 33mm(D33): target CC depth of 33mm with standard AHA epinephrine dosing; or 3) Depth 51mm(D51): target CC depth of 51mm with standard AHA epinephrine dosing. All animals received manual CPR guided by audiovisual feedback for 10 minutes before first shock. 45-minute survival was higher in the CPP-20 group (8/8) compared to D33 (1/8) or D51 (3/8) groups; p=0.002. Coronary perfusion pressures were higher in the CPP-20 group compared to D33 (p=0.004) and D51 (p=0.006), and in survivors compared to non-survivors (p<0.01). Total epinephrine dosing and defibrillation attempts were not different. Hemodynamic directed resuscitation targeting CPPs > 20 mmHg during 10 minutes of CPR for VF cardiac arrest improves short-term survival, when compared to resuscitation with depth of compressions guided to 33mm or 51mm and standard AHA vasopressor dosing.