Saïssy J M, Boussignac G, Cheptel E, Rouvin B, Fontaine D, Bargues L, Levecque J P, Michel A, Brochard L
Service d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées BEGIN, Saint-Mandé, France.
Anesthesiology. 2000 Jun;92(6):1523-30. doi: 10.1097/00000542-200006000-00007.
During experimental cardiac arrest, continuous insufflation of air or oxygen (CIO) through microcannulas inserted into the inner wall of a modified intubation tube and generating a permanent positive intrathoracic pressure, combined with external cardiac massage, has previously been shown to be as effective as intermittent positive pressure ventilation (IPPV).
After basic cardiorespiratory resuscitation, the adult patients who experienced nontraumatic, out-of-hospital cardiac arrest with asystole, were randomized to two groups: an IPPV group tracheally intubated with a standard tube and ventilated with standard IPPV and a CIO group for whom a modified tube was inserted, and in which CIO at a flow rate of 15 l/min replaced IPPV (the tube was left open to atmosphere). Both groups underwent active cardiac compression-decompression with a device. Resuscitation was continued for a maximum of 30 min. Blood gas analysis was performed as soon as stable spontaneous cardiac activity was restored, and a second blood gas analysis was performed at admission to the hospital.
The two groups of patients (47 in the IPPV and 48 in the CIO group) were comparable. The percentages of patients who underwent successful resuscitation (stable cardiac activity; 21.3 in the IPPV group and 27.1% in the CIO group) and the time necessary for successful resuscitation (11.8 +/- 1.8 and 12.8 +/- 1.9 min) were also comparable. The blood gas analysis performed after resuscitation (8 patients in the IPPV and 10 in the CIO group) did not show significant differences. The arterial blood gases performed after admission to the hospital and ventilation using a transport ventilator (seven patients in the IPPV group and six in the CIO group) showed that the partial pressure of arterial carbon dioxide (PaCO2) was significantly lower in the CIO group (35.7 +/- 2.1 compared with 72.7 +/- 7.4 mmHg), whereas the pH and the partial pressure of arterial oxygen (PaO2) were significantly higher (all P < 0.05).
Continuous insufflation of air or oxygen alone through a multichannel open tube was as effective as IPPV during out-of-hospital cardiac arrest. A significantly greater elimination of carbon dioxide and a better level of oxygenation in the group previously treated with CIO probably reflected better lung mechanics.
在实验性心脏骤停期间，通过插入改良插管内壁的微套管持续吹入空气或氧气（CIO）并产生持续的胸内正压，结合体外心脏按压，此前已证明其效果与间歇正压通气（IPPV）相当。
在进行基本心肺复苏后，将经历非创伤性院外心脏骤停且为心搏停止的成年患者随机分为两组：一组为IPPV组，使用标准气管插管进行气管插管并采用标准IPPV通气；另一组为CIO组，插入改良插管，以15升/分钟的流速进行CIO取代IPPV（插管保持与大气相通）。两组均使用设备进行主动心脏按压 - 减压。复苏持续最长30分钟。一旦恢复稳定的自主心脏活动，立即进行血气分析，并在入院时进行第二次血气分析。
两组患者（IPPV组47例，CIO组48例）具有可比性。成功复苏的患者百分比（稳定的心脏活动；IPPV组为21.3%，CIO组为27.1%）以及成功复苏所需时间（11.8±1.8分钟和12.8±1.9分钟）也具有可比性。复苏后进行的血气分析（IPPV组8例，CIO组10例）未显示出显著差异。入院后使用转运呼吸机通气后进行的动脉血气分析（IPPV组7例，CIO组6例）显示，CIO组的动脉二氧化碳分压（PaCO2）显著更低（35.7±2.1 mmHg，而IPPV组为72.7±7.4 mmHg），而pH值和动脉血氧分压（PaO2）显著更高（所有P<0.05）。
在院外心脏骤停期间，通过多通道开放插管单独持续吹入空气或氧气与IPPV效果相当。先前接受CIO治疗的组中二氧化碳清除显著增加且氧合水平更好，这可能反映了更好的肺力学情况。
