Beyersdorf F, Kirsh M, Buckberg G D, Allen B S
Department of Thoracic Surgery, Johann Wolfgang Goethe-University Frankfurt, Germany.
J Thorac Cardiovasc Surg. 1992 Oct;104(4):1141-7.
This report describes an initial experience applying warm glutamate/aspartate substrate-enriched blood cardioplegic solution to resuscitate hearts in 14 patients with witnessed perioperative arrest. Ten patients were in stable hemodynamic condition in the catheterization laboratory (n = 3) or intensive care unit when sudden irreversible fibrillation developed. It progressed to electromechanical arrest in six patients. In patients with preoperative or postoperative arrest, conventional cardiopulmonary resuscitation and defibrillation were unsuccessful and extracorporeal circulation was started 22 to 150 minutes after arrest. The left ventricle was vented, the aorta clamped, and warm (37 degrees C) aspartate/glutamate blood cardioplegic solution was given at a rate of 150 ml/min for 20 minutes. All bypass grafts were open with good flows in patients who had had coronary bypass, and coronary bypass was done in the three patients who had preoperative arrest. Eleven of 14 hearts resumed normal sinus rhythm after aortic unclamping, only two electrocardiographically proved infarctions occurred, and 13 patients had complete hemodynamic recovery with improved ejection fraction. Three patients died: one of progressive cardiogenic shock, another of mediastinitis, and the third of irreversible neurologic damage. Eleven patients were discharged from the hospital and are well after a follow-up period between 3 and 9 months. We conclude that witnessed perioperative arrest with intractable ventricular fibrillation should be treated aggressively by administering cardiopulmonary resuscitation during prompt transfer to the operating room for total vented bypass and delivery of warm substrate-enriched blood cardioplegic solution. This treatment may salvage hearts thought to be damaged irreversibly and may be a feasible approach to intractable witnessed cardiac arrest, provided cardiopulmonary resuscitation maintains satisfactory cerebral perfusion pressure.
本报告描述了将富含谷氨酸/天冬氨酸底物的温血心脏停搏液应用于14例围手术期心脏骤停患者心脏复苏的初步经验。10例患者在导管室（n = 3）或重症监护病房处于血流动力学稳定状态时突然发生不可逆性颤动，其中6例进展为电机械性心脏骤停。对于术前或术后发生心脏骤停的患者，常规心肺复苏和除颤均未成功，心脏骤停后22至150分钟开始体外循环。左心室进行排气，夹闭主动脉，以150 ml/min的速度给予温（37℃）天冬氨酸/谷氨酸血心脏停搏液20分钟。接受冠状动脉搭桥术的患者所有旁路移植物均通畅且血流良好，3例术前心脏骤停患者进行了冠状动脉搭桥术。14例患者中有11例在松开主动脉夹后恢复正常窦性心律，仅发生2例经心电图证实的梗死，13例患者血流动力学完全恢复且射血分数提高。3例患者死亡：1例死于进行性心源性休克，另1例死于纵隔炎，第3例死于不可逆性神经损伤。11例患者出院，在3至9个月的随访期后情况良好。我们得出结论，对于围手术期发生的、伴有顽固性心室颤动的心脏骤停，应在迅速转运至手术室进行全排气旁路并给予富含温底物的血心脏停搏液的过程中积极进行心肺复苏治疗。这种治疗方法可能挽救被认为已发生不可逆损伤的心脏，并且可能是治疗顽固性心脏骤停的一种可行方法，前提是心肺复苏能维持令人满意的脑灌注压。
