Post-Countershock CPR After Prolonged VF

描述(由申请人提供)： 每天有300多名美国人在院前环境中死于长时间的VF。虽然除颤是室颤的首选治疗方法，但长时间的室颤除颤通常会导致非灌注性节律(停搏或无脉搏电活动)。在院前环境中延长室颤后，除颤后成功复苏为无脉搏节律的情况很少见。这项建议的目的是开发一种新的策略来治疗院前长时间的室性心动骤停。抗休克后快速心肺复苏对于延长室颤后无灌流节律的动物是有效的，但很少在院前环境中提供。自动体外除颤器(AED)通常是第一种可用的除颤器，反休克后自动心电节律分析和休克咨询的延迟，加上临床评估的延迟，阻碍了反休克后CPR的及时进行。这些与AED相关的延迟干扰了动物模型和临床院前护理的成功复苏。我们的假设是，在第一次反休克后立即恢复血流将改善延长的室颤的预后。为了验证我们的假设，我们建议追求以下具体目标。第一个目标是通过评估：a)单次电击和一系列多达3次的电击，b)在没有事先的临床评估或节律评估的情况下立即进行1min和3min的反休克后CPR，以及c)单独的胸部按压和胸部按压加抢救性呼吸，来确定反休克后最佳的血流优化技术。主要终点将是成功的初始复苏。复苏后的心肌功能、24小时存活期、神经状态以及反休克后的初始心肌和全身代谢状态也将被评估。目的2是比较“最佳”抗休克后血流优化技术和标准护理(即，叠加休克，然后胸部按压加抢救呼吸，在第一次抗休克后1分钟开始)。目的#3是使用猪急性心肌梗死模型，比较“最佳”反休克后血流优化技术与标准护理。AIMS#2和#3的主要终点是48小时存活期和良好的神经预后。这项研究的结果应该会转化为一种更成功的新治疗策略，在延长室颤后恢复心脏功能和保护神经功能。

DESCRIPTION (provided by applicant): More than 300 Americans die from prolonged VF in the prehospital setting each day. Although defibrillation is the treatment of choice for VF, defibrillation from prolonged VF usually results in non-perfusing rhythms (asystole or pulseless electrical activity). Successful resuscitation after defibrillation into a pulseless rhythm is rare after prolonged VF in the prehospital setting. The objective of this proposal is to develop a new strategy for the treatment of prolonged prehospital VF cardiac arrest. Prompt post-countershock CPR is effective for resuscitation of animals with non-perfusing rhythms after prolonged VF, but is rarely provided in the prehospital setting. Automated external defibrillators (AEDs) are generally the first available defibrillator, and the delays from the post-countershock automated electrocardiographic rhythm analysis and shock advisory, coupled with delays due to clinical assessment, preclude prompt post-countershock CPR. These AED-associated delays interfere with successful resuscitation in animal models and in clinical prehospital care. Our hypothesis is that prompt restoration of blood flow immediately after the first countershock will improve outcome from prolonged VF. To test our hypothesis, we propose to pursue the following specific aims. Aim #1 is to determine a "best" post-countershock blood flow optimizing technique by evaluating: a) single shocks vs series of up to 3 stacked shocks, b) immediate post-countershock CPR for 1 vs 3 minutes without prior clinical evaluation or rhythm assessment, and c) chest compressions alone vs chest compressions plus rescue breathing. The primary endpoint will be successful initial resuscitation. Post-resuscitation myocardial function, 24-hour survival, neurological status, and initial post-countershock myocardial and systemic metabolic status will also be evaluated. Aim #2 is to compare the "best" post-countershock blood flow optimizing technique versus standard care (i.e., stacked shocks, followed by chest compressions plus rescue breathing commencing 1 minute after the first countershock). Aim #3 is to compare the "best" post-countershock blood flow optimizing technique versus standard care, using a swine model with acute myocardial infarction. The primary endpoint for Aims #2 and #3 is 48-hour survival with good neurological outcome. The results of this study should translate into a more successful new therapeutic strategy to restore heart function and preserve neurological function after prolonged VF.