RESUSCITATION AFTER PROLONGED CARDIAC ARREST

心脏复苏的条件是迅速恢复 心肌灌注与有氧心肌重建 新陈代谢。通过常规的闭胸心肺复苏技术， 恢复“猝死”可供扭转“猝死”的时间 心肌灌注通常被限制在大约8 几分钟。8分钟后，可复苏并长期存活 都很遥远。 此应用程序解决了改善心肌梗死的选项 心脏延长后的可复苏性和长期预后 逮捕。我们建议比较体外循环泵给氧 (ECPO)利用股动脉和颈静脉通路和 开胸术后心内按摩(ICM)干预 在临床10、15和20分钟后进行心脏复苏 动物模型中的死亡。 利用已建立的猪模型，在该模型中， 会诱发出纤颤。我们之前已经演示过 危重功能恢复后的复苏和48小时存活 在此模型中，当ECPO在以下时间间隔15分钟后启动 循环骤停。 计划进行三组实验，在这些实验中保持VF 在没有干预的情况下进行10、15或20分钟。未能做到 体外反休克后恢复循环，ICM或ECPO 是被利用的。 我们预计，ECPO将提供更优化的系统和 心肌血流量，更强的复苏力，更好的48小时 存活率和比心内膜更好的神经预后 按摩。当临床死亡年限由10年延长时 到15分钟，然后到20分钟，这样的差异 有效性可能会被放大。作为……的重要组成部分 这项研究，我们预计呼气末二氧化碳压力 (P与肺血流量密切相关，因此 心脏心肺复苏术，作为一种非侵入性监测仪，引导 启动和停止这些高级生命支持 技巧。 这些研究旨在作为规划的基础 ECPO(可能还有ICM)管理的临床评估 持续长时间心脏骤停的患者和不能 常规闭胸复苏成功 心脏受压。我们计划建立客观的衡量标准 尤其是无创PETC02监测引导适当 选择ICM和/或ECPO干预措施中的一种或两种。

Cardiac resuscitation is contingent on prompt restoration of myocardial perfusion with reestablishment of aerobic myocardial metabolism. With conventional techniques of closed-chest CPR, the time available for reversing "sudden death" by restoration of myocardial perfusion is typically limited to approximately 8 minutes. After 8 minutes, resuscitability and long term survival are remote. This application addresses options for improving myocardial resuscitability and long term outcome after prolonged cardiac arrest. We propose to compare extracorporeal pump oxygenation (ECPO) utilizing femoral artery and jugular vein access and internal cardiac massage (ICM) after thoracotomy as interventions for cardiac resuscitation after 10, 15 and 20 minutes of clinical death in an animal model. A well established porcine model is utilized in which ventricular fibrillation is induced. We have previously demonstrated resuscitation and 48-hour survival with return of critical function in this model when ECPO was started after an interval of 15 min of circulatory arrest. Three sets of experiments are planned in which VF is maintained for either 10, 15 or 20 minutes without intervention. Failing to restore circulation after external countershock, either ICM or ECPO is utilized. We anticipate that ECPO will provide more optimal systemic and myocardial blood flow, greater resuscitability, greater 48-hour survival, and better neurological outcome than internal cardiac massage. When the duration of clinical death is prolonged from 10 to 15 and subsequently to 20 minutes, such differences in effectiveness are likely to be magnified. As an important part of this study, we anticipate that the end-tidal carbon dioxide tension (P which correlates closely with pulmonary blood flow and therefore cardiac CPR, serves as a noninvasive monitor for guiding both initiation and discontinuation of these advanced life support techniques. These studies are intended to serve as the basis for planning clinical evaluation of ECPO (and possibly ICM) for the management of patients who sustain prolonged cardiac arrest and who cannot be successfully resuscitated by conventional methods of closed chest cardiac compression. We plan to establish objective measurements and especially noninvasive PETC02 monitoring to guide appropriate selection and timing of either or both ICM and ECPO interventions.