Manning J E, Katz L M, Pearce L B, Batson D N, McCurdy S L, Gawryl M S, Baker C C
Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7594, USA.
Crit Care Med. 2001 Nov;29(11):2067-74. doi: 10.1097/00003246-200111000-00005.
The prospects for resuscitation after blunt traumatic cardiac arrest are dismal. Selective aortic arch perfusion (SAAP) with a hemoglobin-based oxygen carrier (HBOC-201) offers a potentially effective therapy. This study evaluated the acute cardiovascular and metabolic effects of SAAP with HBOC-201 in an exsanguination model of cardiac arrest.
Randomized, controlled, laboratory investigation.
University research laboratory.
Domestic swine, 25-39 kg.
Partial resection of four liver lobes rapidly led to profound hemorrhagic shock and subsequent cardiac arrest at 10-13 mins. At 15 mins, swine were randomized to receive either SAAP with oxygenated lactated Ringer's (LR) solution (n = 6) or SAAP with oxygenated HBOC-201 (n = 6) at a rate of 10 mL x kg(-1) x min(-1) until return of spontaneous circulation with a mean aortic pressure of 60 mm Hg (8.0 kPa) was achieved. Epinephrine (0.005 mg/kg) was given via intra-aortic route every 30 secs as needed to promote return of spontaneous circulation beginning at 18 mins after onset of liver injury (3 mins after beginning SAAP).
Mean aortic pressure, cardiac output, total blood loss, and time of arrest were similar for both groups before SAAP therapy. In the SAAP-HBOC group, return of spontaneous circulation with a sustained mean aortic pressure of 60 mm Hg (8.0 kPa) was achieved in six of six swine at 1.9 +/- 0.3 mins of SAAP, and none of these swine required epinephrine. In the SAAP-LR group, no swine (from a total of six) achieved return of spontaneous circulation before intra-aortic epinephrine administration, and only two of six swine had brief return of spontaneous circulation with an mean aortic pressure of 60 mm Hg (8.0 kPa) after intra-aortic epinephrine that was sustained for <10 mins. One-hour survival was five of six in the SAAP-HBOC group and none of six in the SAAP-LR group (p <.05, Fisher's exact test).
SAAP with oxygenated HBOC-201 rapidly restored viable cardiovascular function after exsanguinating cardiac arrest in this swine model of liver injury with profound hemorrhagic shock.
钝性创伤性心脏骤停后的复苏前景不容乐观。基于血红蛋白的氧载体（HBOC-201）进行选择性主动脉弓灌注（SAAP）提供了一种潜在有效的治疗方法。本研究评估了在心脏骤停放血模型中SAAP联合HBOC-201的急性心血管和代谢效应。
随机对照实验室研究。
大学研究实验室。
体重25 - 39千克的家猪。
快速部分切除四个肝叶导致严重失血性休克，并在10 - 13分钟后引发心脏骤停。15分钟时，将猪随机分为两组，分别接受以10 mL×kg⁻¹×min⁻¹的速率用氧合乳酸林格氏液（LR）进行SAAP（n = 6）或用氧合HBOC-201进行SAAP（n = 6），直至实现自主循环恢复且平均主动脉压达到60 mmHg（8.0 kPa）。从肝损伤开始后18分钟（SAAP开始后3分钟）起，根据需要每30秒通过主动脉内途径给予肾上腺素（0.005 mg/kg）以促进自主循环恢复。
SAAP治疗前，两组的平均主动脉压、心输出量、总失血量和心脏骤停时间相似。在SAAP-HBOC组中，6头猪中有6头在SAAP 1.9±0.3分钟时实现了自主循环恢复，且平均主动脉压维持在60 mmHg（8.0 kPa），这些猪均未需要肾上腺素。在SAAP-LR组中，6头猪（共6头）在主动脉内给予肾上腺素前均未实现自主循环恢复，6头猪中只有2头在主动脉内给予肾上腺素后短暂恢复自主循环，平均主动脉压为60 mmHg（8.0 kPa），且持续时间<10分钟。SAAP-HBOC组1小时生存率为6头中的5头，SAAP-LR组6头中无一存活（p <.05，Fisher精确检验）。
在这个伴有严重失血性休克的肝损伤猪模型中，用氧合HBOC-201进行SAAP能在心脏骤停放血后迅速恢复有效的心血管功能。
