EFFECTS OF HYPOTHERMIC EXTRACORPOREAL LUNG AND HEART ASSIST (ECLHA) ON CARDIOPULMONARY AND CEREBRAL RESUSCITATION

低温体外肺心辅助 (ECLHA) 对心肺和脑复苏的影响

• 批准号: 11470325
• 负责人: TERASAKI Hidenori
• 金额: $ 8.77万
• 依托单位: KUMAMOTO UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B).
• 财政年份: 1999
• 资助国家: 日本
• 起止时间: 1999 至 2000
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-11470325/
• 关键词: Cardiac arrest; Resuscitation; Extracorporeal circulation; Hypothermia; Artificial membrane lung; Extracorporeal lung and heart assist; Cerebral resuscitation; 模型人工肺

Background and purpose : Although normothermic extracorporeal lung and heart assist (ECLHA) improves cardiac outcomes, patients can not benefit from hypothermia-mediated brain protection. The present study evaluated the effects of long-term ECLHA with mild to moderate hypothermia (33℃) in a canine model of prolonged cardiac arrest.Methods : Fifteen dogs were assigned to either the hypothermic (7 dogs, 33℃) or normothermic group (8 dogs, 37.5℃). All dogs were induced to normothermic ventricular fibrillation (VF) for 15 min, followed by 24 h of ECLHA and 72 h of intensive care. The hypothermia group maintained core (pulmonary artery) temperature at 33℃ for 20 h starting from resuscitation, then were rewarmed by 28 h. Outcome evaluations included : 1. mortality, 2. catecholamine dose, 3. time to extubation, 4. necrotic myocardial mass (g), 5. Neurological Deficits Score (NDS).Results : In the normothermic group 4 dogs died of cardiogenic shock and 1 dog succumbed to poor oxygenation. The 2 surviving dogs remained comatose (NDS 60.5 ± 4.9%) with necrotic myocardial mass of 14.5 ± 3.5 g. In the hypothermic group, one dog died from pulmonary dysfunction, the other 6 dogs survived. The surviving dogs showed brain damage (29.8 ± 2.5%), but there was evidence of some brain-protective effect. The mass of necrotic myocardium was 4.2 ± 1.3 g in the hypothermic group or 3.4 times smaller than in the normothermic group. The survival rate was significantly higher in the hypothermic than in the normothermic group (P<0.01). The catecholamine requirement was also lower in the hypothermic than in the normothermic dogs (P<0.05).Conclusions : Long-term mild to moderate hypothermia with ECLHA induced immediately after cardiac arrest improved survival as well as cerebral and cardiac outcomes.

背景和目的：尽管常温体外心肺辅助(ECLHA)可以改善心脏功能，但患者并不能从低温介导的脑保护中受益。方法：15只犬随机分为亚低温组(7只，33℃)和常温组(8只，37.5℃)。所有犬均诱发常温室颤(VF)15min，然后进行ECLHA治疗24 h和重症监护72 h。结果：常温组4只犬死于心源性休克，1只犬死于低氧。结果：1.死亡率，2.儿茶酚胺用量，3.拔管时间，4.坏死性心肌质量(G)，5.神经功能障碍评分(NDS)。结果：常温组4只犬死于心源性休克，1只犬死于低氧合。存活的2只犬仍处于昏迷状态(NDS 60.5±4.9%)，心肌坏死质量为14.5±3.5g，亚低温组1只犬死于肺功能障碍，其余6只存活。存活犬出现脑损伤(29.8±2.5%)，但有一定的脑保护作用。亚低温组坏死区心肌质量为4.2±1.3g，比常温组小3.4倍。亚低温组的存活率显著高于常温组(P&lt；0.01)。低温组的儿茶酚胺需要量也低于常温组(P&lt；0.05)。结论：在心脏骤停后立即行ECLHA的长期亚低温可以改善患者的存活率以及脑心功能。

项目成果

Ao H,Tanimoto H,Yositaka A,Moon JK,Terasaki H: "Long term mild hypothermia with ECLHA improved survival in prolonged cardiac arrest dogs"Resuscitation. 48・. 163-174 (2001)

Ao H、Tanimoto H、Yositaka A、Moon JK、Terasaki H：“ECLHA 的长期轻度低温改善了长时间心脏骤停狗的存活率”48·163-174 (2001)。

Sakanashi Y, Tanimoto H, Okamoto T, Tashiro M, Ao H and Terasaki H: "Total and prolonged filling of the lungs with Ringer's solution under extracorporeal lung assist (ECLA) in dogs."Acta Anesthesiologica Scandinavica. 44. 994-1001 (2000)

Sakanashi Y、Tanimoto H、Okamoto T、Tashiro M、Ao H 和 Terasaki H：“在体外肺辅助 (ECLA) 下，狗的肺部完全且长时间地充满林格液。”Acta Anesthesiologica Scandinavica。

Ao H, Tanimoto H, Yositake A, Moon JK and Terasaki H: "Heparin bonded extracorporeal circuit reduces thrombosis during prolonged lung assist in goats."American Society for Artificial Internal Organs Journal. 46. 723-729 (2000)

Ao H、Tanimoto H、Yositake A、Moon JK 和 Terasaki H：“肝素结合的体外回路可减少山羊长期肺辅助过程中的血栓形成。”美国人工内脏器官学会杂志。

Sakanashi Y,Tanimoto H,Okamoto T,Tashiro M,Ao H,Terasaki H: "Total and prolonged filling of the lungs with Ringer's solution under extracorporeal lung assist (ECLA) in dogs"Acta Anesthesiologica Scandinavica. 44・. 994-1001 (2000)

Sakanashi Y、Tanimoto H、Okamoto T、Tashiro M、Ao H、Terasaki H：“体外肺辅助 (ECLA) 下狗的肺部完全和长时间充盈”Acta Anesthesiologica Scandinavica 44·。 2000)

Ao H, Tanimoto H, Yositake A, Moon JK and Terasaki H: "Long term mild hypothermia with ECLHA improved survival in prolonged cardiac arrest dogs."Resuscitation. 48. 163-174 (2001)

Ao H、Tanimoto H、Yositake A、Moon JK 和 Terasaki H：“ECLHA 的长期轻度低温改善了长时间心脏骤停狗的存活率。”复苏。