通过冷主动脉灌注快速诱导轻度脑低温可使在经历20分钟放血心脏骤停的犬类结局模型中实现正常恢复。

Rapid induction of mild cerebral hypothermia by cold aortic flush achieves normal recovery in a dog outcome model with 20-minute exsanguination cardiac arrest.

作者信息

Behringer W, Prueckner S, Safar P, Radovsky A, Kentner R, Stezoski S W, Henchir J, Tisherman S A

机构信息

Safar Center for Resuscitation Research, Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

出版信息

Acad Emerg Med. 2000 Dec;7(12):1341-8. doi: 10.1111/j.1553-2712.2000.tb00489.x.

DOI:10.1111/j.1553-2712.2000.tb00489.x

PMID:11099422

Abstract

OBJECTIVES

Resuscitation attempts in trauma victims who suffer cardiac arrest (CA) from exsanguination almost always fail. The authors hypothesized that an aortic arch flush with cold normal saline solution (NSS) at the start of exsanguination CA can preserve cerebral viability during 20-minute no-flow.

METHODS

Twelve dogs were exsanguinated over 5 minutes to CA of 20-minute no-flow, resuscitated by cardiopulmonary bypass, followed by post-CA mild hypothermia (34 degrees C) continued to 12 hours, controlled ventilation to 20 hours, and intensive care to 72 hours. At CA 2 minutes, the dogs received a 500-mL flush of NSS at either 24 degrees C (group 1, n = 6) or 4 degrees C (group 2, n = 6), using a balloon-tipped catheter inserted via the femoral artery into the descending thoracic aorta.

RESULTS

The flush at 24 degrees C (group 1) decreased tympanic membrane temperature [mean (+/-SD)] from 37.5 degrees C (+/-0.1) to 35.7 degrees C (+/-0.2); the flush at 4 degrees C (group 2) to 34.0 degrees C (+/-1.1) (p = 0.005). In group 1, one dog achieved overall performance category (OPC) 2 (moderate disability), one OPC 3 (severe disability), and four OPC 4 (coma). In group 2, four dogs achieved OPC 1 (normal), one OPC 2, and one OPC 3 (p = 0.008). Neurologic deficit scores (0-10% normal, 100% brain death) [median (25th-75th percentile)] were 62% (40-66) in group 1 and 5% (0-19) in group 2 (p = 0.01). Total brain histologic damage scores were 130 (62-137) in group 1 and 24 (10-55) in group 2 (p = 0.008).

CONCLUSIONS

Aortic arch flush of 4 degrees C at the start of CA of 20 minutes rapidly induces mild cerebral hypothermia and can lead to normal functional recovery with minimal histologic brain damage. The same model with aortic arch flush of 24 degrees C results in survival with brain damage in all dogs, which makes it suitable for testing other (e.g., pharmacologic) preservation potentials.

摘要

目的

因失血导致心脏骤停（CA）的创伤患者复苏尝试几乎总是失败。作者推测，在失血导致CA开始时用冷生理盐水溶液（NSS）冲洗主动脉弓可在20分钟无血流期间维持脑存活能力。

方法

12只犬在5分钟内失血至CA并维持20分钟无血流，通过体外循环复苏，随后进行CA后轻度低温（34℃）并持续12小时，控制通气20小时，重症监护72小时。在CA 2分钟时，使用经股动脉插入降主动脉的带球囊导管，给犬输注500 mL 24℃（第1组，n = 6）或4℃（第2组，n = 6）的NSS。

结果

24℃冲洗（第1组）使鼓膜温度[均值（±标准差）]从37.5℃（±0.1）降至35.7℃（±0.2）；4℃冲洗（第2组）降至34.0℃（±1.1）（p = 0.005）。在第1组中，1只犬达到总体表现类别（OPC）2（中度残疾），1只OPC 3（重度残疾），4只OPC 4（昏迷）。在第2组中，4只犬达到OPC 1（正常），1只OPC 2，1只OPC 3（p = 0.008）。神经功能缺损评分（0 - 10%正常，100%脑死亡）[中位数（第25 - 75百分位数）]在第1组为62%（40 - 66），在第2组为5%（0 - 19）（p = 0.01）。全脑组织学损伤评分在第1组为130（62 - 137），在第2组为24（10 - 55）（p = 0.008）。