Rubertsson S, Bircher N G, Smarik S D, Young M C, Alexander H, Grenvik A
Department of Anesthesiology and Critical Care Medicine and Safar Center for Resuscitation Research, University of Pittsburgh, PA, USA.
Resuscitation. 1999 Sep;42(1):57-63. doi: 10.1016/s0300-9572(99)00075-1.
Intra-aortic balloon occlusion during experimental cardiopulmonary resuscitation (CPR) improves coronary perfusion pressure and resuscitability and provides unique access to the central circulation. It has been hypothesized that administration of epinephrine into the aortic arch in combination with aortic occlusion would further improve haemodynamics during CPR, resuscitability and 24 h survival. In 16 anaesthetised dogs intravascular catheters were placed for hemodynamic and blood gas monitoring. An aortic balloon catheter was placed by femoral artery insertion with its tip just distal to the left subclavian artery. Ventricular fibrillation for 7.5 min without CPR, 2.5 min of Basic Life Support with chest compressions and ventilation with 100% oxygen were followed by 30 min of Advanced Cardiac Life Support (ACLS) with systemic canine drug dosages. The intra-aortic balloon was inflated when ACLS started and gradually deflated shortly after restoration of spontaneous circulation (ROSC). Epinephrine, in 100 microg/kg boluses every 5 min until the heart was restarted or 30 min had elapsed was administered through the intra-aortic catheter in the experimental group (n = 8) and via a central venous catheter in the control group (n = 8). Coronary perfusion pressure increased during the ACLS period in both groups (P < 0.05) with no difference between the groups and there was no difference in the frequency of ROSC (experimental group 5/8, control group 4/8). Furthermore with respect to 24 h survival, there was no difference between the experimental group (2/8) and the control group (3/8). Severe macroscopic haemorrhagic necrosis of the myocardium in the dogs with ROSC was found in 4/5 in the experimental group compared to 1/4 in the control group. In conclusion, intra-aortic administration of 100 microg/kg epinephrine doses combined with aortic occlusion during experimental CPR did not alter outcome.
在实验性心肺复苏（CPR）期间进行主动脉内球囊阻塞可提高冠状动脉灌注压和复苏成功率，并提供进入中心循环的独特途径。有人推测，在主动脉弓内注射肾上腺素并结合主动脉阻塞可在CPR期间进一步改善血流动力学、复苏成功率和24小时生存率。在16只麻醉犬中放置血管内导管用于血流动力学和血气监测。通过股动脉插入放置一根主动脉球囊导管，其尖端位于左锁骨下动脉远端。先在无CPR的情况下诱发室颤7.5分钟，然后进行2.5分钟的基础生命支持，包括胸外按压和100%氧气通气，随后进行30分钟的高级心脏生命支持（ACLS），采用犬类全身用药剂量。在ACLS开始时充盈主动脉内球囊，并在自主循环恢复（ROSC）后不久逐渐放气。在实验组（n = 8）中，每5分钟通过主动脉内导管给予100μg/kg肾上腺素推注，直至心脏重新启动或30分钟过去；在对照组（n = 8）中，通过中心静脉导管给予肾上腺素。两组在ACLS期间冠状动脉灌注压均升高（P < 0.05），组间无差异，ROSC频率也无差异（实验组5/8，对照组4/8）。此外，关于24小时生存率，实验组（2/8）和对照组（3/8）之间无差异。实验组中5/4有ROSC的犬出现严重的心肌宏观出血性坏死，而对照组为1/4。总之，在实验性CPR期间，主动脉内给予100μg/kg肾上腺素剂量并结合主动脉阻塞并未改变结果。
