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期VF。 虽然除颤是VF的治疗选择，但长时间VF的除颤通常会导致非灌注节律（心搏停止或无脉电活动）。 在院前环境中，长时间室颤后，除颤至无脉心律后成功复苏是罕见的。 本提案的目的是制定一种新的策略，用于治疗院前长时间室颤心脏骤停。 快速反休克后CPR对长时间VF后无灌注节律的动物复苏有效，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，并且来自反电击后自动心电图节律分析和电击咨询的延迟，加上由于临床评估而导致的延迟，排除了迅速的反电击后CPR。 这些AED相关的延迟干扰了动物模型和临床院前护理中的成功复苏。 我们的假设是，在第一次反电击后立即迅速恢复血流将改善长期VF的结局。 为了检验我们的假设，我们建议追求以下具体目标。 目标#1是通过评估确定“最佳”反休克后血流优化技术：a）单次电击与最多3次叠加电击的系列，B）在没有事先临床评价或心律评估的情况下，立即进行1分钟与3分钟的反休克后CPR，以及c）单独胸外按压与胸外按压加人工呼吸。 主要终点是成功的初始复苏。 还将评价复苏后心肌功能、24小时存活率、神经系统状态以及初始抗休克后心肌和全身代谢状态。 目的#2是比较“最佳”反休克后血流优化技术与标准护理（即，叠加电击，随后是胸部按压加上在第一次反电击后1分钟开始的人工呼吸）。 目的#3是使用猪急性心肌梗死模型，比较“最佳”抗休克后血流优化技术与标准护理。 目标#2和#3的主要终点是48小时生存率和良好的神经学结局。 这项研究的结果应该转化为一个更成功的新的治疗策略，以恢复心脏功能和保护神经功能后，长期VF。

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.