Gazmuri R J, Weil M H, Terwilliger K, Shah D M, Duggal C, Tang W
Department of Medicine, University of Health Sciences, Chicago Medical School, Illinois.
Chest. 1992 Dec;102(6):1846-52. doi: 10.1378/chest.102.6.1846.
Open-chest direct cardiac compression represents a more potent but highly invasive option for cardiac resuscitation when conventional techniques of closed-chest cardiac resuscitation fail after prolonged cardiac arrest. We postulated that venoarterial extracorporeal circulation might be a more effective intervention with less trauma. In the setting of human cardiac resuscitation, however, controlled studies would be limited by strategic constraints. Accordingly, the effectiveness of open-chest cardiac compression was compared with that of extracorporeal circulation after a 15-min interval of untreated ventricular fibrillation in a porcine model of cardiac arrest. Sixteen domestic pigs were randomized to resuscitation by either peripheral venoarterial extracorporeal circulation or open-chest direct cardiac compression. During resuscitation, epinephrine was continuously infused into the right atrium, and defibrillation was attempted by transthoracic countershock at 2-min intervals. Systemic blood flows averaged 198 ml.kg-1.min-1 with extracorporeal circulation. This contrasted with direct cardiac compression, in which flows averaged only 40 ml.kg-1.min-1. Coronary perfusion pressure, the major determinant of resuscitability on the basis of earlier studies, was correspondingly lower (94 vs 29 mm Hg). Extracorporeal circulation, in conjunction with transthoracic DC countershock and epinephrine, successfully reestablished spontaneous circulation in each of eight animals after 15 min of untreated ventricular fibrillation. This contrasted with the outcome after open-chest cardiac compression, in which spontaneous circulation was reestablished in only four of eight animals (p = .038). We conclude that extracorporeal circulation is a more effective alternative to direct cardiac compression for cardiac resuscitation after protracted cardiac arrest.
当长时间心脏骤停后传统的闭胸心脏复苏技术失败时，开胸直接心脏按压是一种更有效但具有高度侵入性的心脏复苏选择。我们推测静脉 - 动脉体外循环可能是一种创伤较小且更有效的干预措施。然而，在人类心脏复苏的情况下，对照研究将受到策略性限制。因此，在猪心脏骤停模型中，比较了在15分钟未经治疗的心室颤动间隔后开胸心脏按压与体外循环的效果。16头家猪被随机分配接受外周静脉 - 动脉体外循环或开胸直接心脏按压进行复苏。在复苏过程中，肾上腺素持续注入右心房，并每隔2分钟尝试经胸除颤。体外循环时全身平均血流量为198 ml·kg⁻¹·min⁻¹。这与直接心脏按压形成对比，直接心脏按压时血流量平均仅为40 ml·kg⁻¹·min⁻¹。根据早期研究，复苏能力的主要决定因素冠状动脉灌注压相应较低（分别为94 vs 29 mmHg）。体外循环联合经胸直流电除颤和肾上腺素，在15分钟未经治疗的心室颤动后成功使8只动物中的每只都恢复了自主循环。这与开胸心脏按压后的结果形成对比，开胸心脏按压后8只动物中只有4只恢复了自主循环（p = 0.038）。我们得出结论，对于长时间心脏骤停后的心脏复苏，体外循环是比直接心脏按压更有效的替代方法。
