Garcia L A, Allan J J, Kerber R E
Department of Internal Medicine, The Cardiovascular Research Center, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
Resuscitation. 2000 Nov;47(3):301-5. doi: 10.1016/s0300-9572(00)00244-6.
Cardiopulmonary resuscitation (CPR) improves survival from cardiac arrest. The interactions between CPR and the new biphasic (BiP) defibrillation waveforms have not been defined. Our purpose was to compare the effect of CPR versus no CPR during BiP and damped sinusoidal (DS) shocks on the termination of ventricular fibrillation (VF) and the resumption of a perfusing rhythm.
We studied 20 pigs; VF was induced electrically and allowed to persist for 6 min. During VF episodes each pig received (in random order): (a) 6 min of full CPR (continuous ventilation and closed chest mechanical compression (Thumper, Michigan Instruments)) followed by DS defibrillation at 100 J; (b) no CPR, DS defibrillation; (c) 6 min of full CPR and BiP defibrillation at 100 J; and (d) no CPR, BiP defibrillation.
BiP shocks with CPR terminated VF in 83% of attempts versus 45% without CPR (15/18 and 5/11 respectively, P<0.05). DS shocks with CPR were successful in terminating VF in 53% of attempts; DS shocks without CPR were successful in 44% (8/15 and 7/16, respectively, P=NS). No animal achieved a perfusing rhythm after shocks of either waveform if CPR did not precede the shocks during the 6-min VF period, whereas if CPR was administered during VF 46% (11/24) of the combined BiP/DS shocks restored a perfusing rhythm (P<0.01).
In this experimental long duration VF model, CPR was essential for a perfusing rhythm after termination of VF by shocks with either waveform. CPR facilitated the termination of VF and resumption of a perfusing rhythm after biphasic waveform defibrillation but not after damped sinusoidal waveform defibrillation.
心肺复苏（CPR）可提高心脏骤停后的生存率。CPR与新型双相（BiP）除颤波形之间的相互作用尚未明确。我们的目的是比较在BiP和阻尼正弦波（DS）电击期间，CPR与不进行CPR对室颤（VF）终止及灌注节律恢复的影响。
我们研究了20头猪；通过电刺激诱发VF并持续6分钟。在VF发作期间，每头猪按随机顺序接受：（a）6分钟的完全CPR（持续通气和胸外机械按压（密歇根仪器公司的Thumper）），随后以100焦耳进行DS除颤；（b）不进行CPR，DS除颤；（c）6分钟的完全CPR和100焦耳的BiP除颤；（d）不进行CPR，BiP除颤。
进行CPR时，BiP电击终止VF的成功率为83%，不进行CPR时为45%（分别为15/18和5/11，P<0.05）。进行CPR时，DS电击终止VF的成功率为53%；不进行CPR时，DS电击的成功率为44%（分别为8/15和7/16，P=无显著差异）。如果在6分钟VF期间电击前未进行CPR，则无论哪种波形电击后均无动物恢复灌注节律，而如果在VF期间进行CPR，则46%（11/24）的BiP/DS联合电击恢复了灌注节律（P<0.01）。
在这个实验性的长时间VF模型中，对于通过任何一种波形电击终止VF后恢复灌注节律而言，CPR至关重要。CPR有助于双相波形除颤后VF的终止及灌注节律的恢复，但对阻尼正弦波波形除颤后无此作用。
