RESUSCITATION AFTER PROLONGED CARDIAC ARREST

心脏复苏取决于迅速恢复 心肌灌注伴有氧心肌重建 新陈代谢. 采用传统的闭胸心肺复苏术， 通过恢复可逆转“猝死”的时间 心肌灌注通常限于约8 分钟 8分钟后，可复苏性和长期存活率 是遥远的。 本申请涉及改善心肌梗死的选择。 长时间心脏停搏后的可复苏性和长期结局 逮捕了 我们建议比较体外泵氧合 （ECPO）使用股动脉和颈静脉入路， 开胸术后心脏内按摩（ICM）作为干预措施 在临床治疗10、15和20分钟后进行心脏复苏 在动物模型中死亡。 利用良好建立的猪模型，其中心室 诱发纤维性颤动。 之前我们已经证实 复苏和48小时存活率，关键功能恢复 在该模型中，当ECPO在15分钟的间隔后开始时， 循环停止 计划进行三组维持VF的实验 持续10、15或20分钟而不进行干预。 未能 在外部反电击后恢复循环，ICM或ECPO 被利用。 我们预计，ECPO将提供更优化的系统和 心肌血流量，更大的可复苏性，更长的48小时 生存率和神经功能结局优于心内直视手术 按摩 当临床死亡的持续时间从10 到15分钟，然后到20分钟， 有效性可能会被放大。 的重要组成部分 在这项研究中，我们预计呼气末二氧化碳张力 （P与肺血流量密切相关，因此 心脏CPR，作为一种无创监测器， 启动和停止这些高级生命支持系统 技术. 这些研究旨在作为规划的基础 ECPO（以及可能的ICM）用于管理的临床评价 持续长时间心脏骤停的患者， 常规闭胸复苏成功 心脏按压 我们计划建立客观的测量 特别是非侵入性PETC 02监测，以指导适当的 ICM和ECPO干预措施之一或两者的选择和时机。

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.