Bassuk Jorge A, Wu Dongmei, Lozano Hector, Arias Jaqueline, Kurlansky Paul, Lamas Gervasio A, Adams Jose A
Mt. Sinai Medical Center, Division of Neonatology, 3-BLUM, 4300 Alton Road, Miami Beach, FL 33140, United States.
Resuscitation. 2008 May;77(2):250-7. doi: 10.1016/j.resuscitation.2007.11.018. Epub 2008 Jan 31.
Whole body periodic acceleration (pGz) along the spinal axis is a novel method of cardiopulmonary resuscitation (CPR). Oscillatory motion of the supine body in a horizontal fashion provides ventilation and blood flow to vital organs during cardiac arrest and pulsatile shear stress to the vascular endothelium. We previously showed in pigs that pGz-CPR affords better overall survival, post resuscitation myocardial function, and neurological outcomes compared to conventional chest compression CPR. pGz through pulsatile shear stress on the vascular endothelium elicits acute production of prostaglandins and endothelial-derived nitric oxide (eNO) in whole animal models and in vitro preparations. The salutary effects associated with pGz-CPR compared to chest compression CPR are in part related to endothelial-derived nitric oxide. Both eNO and prostaglandins are cardioprotective in ischemia reperfusion models. To differentiate between the roles of these mediators, indomethacin a non-selective cyclooxygenase inhibitor (COX) was used as a tool to investigate prostaglandin effects during pGz-CPR by acute outcomes of survival, cardioprotection and regional blood flows (RBF). Two groups of anesthetized, intubated pigs weighing 25-36kg were studied. Prior to electrical induction of ventricular fibrillation (VF) animals received equal volumes of either saline placebo Control (CONT) (n=9) or indomethacin (INDO), (n=8), (2mg/kg). After 3min of unsupported VF, both groups received 15min of pGz-CPR followed by pharmacologic and electrical attempts for resuscitation. Return of circulation (ROSC) to 3h occurred in (78%) in CONT and (63%) in INDO pretreated animals. There was no statistically significant difference in hemodynamics between groups at baseline or during the protocol. At baseline, INDO caused a decrease in brain RBF. Two hours after ROSC, INDO blunted the hyperemia response to brain and heart. Echocardiographic evidence of myocardial dysfunction was most notable for the INDO group in the wall motion score index (WMSI). After 3h of ROSC there was a 4-fold difference in both creatine phosphokinase (CPK) and Troponin I concentration between INDO and CONT. Therefore, non-specific acute inhibition of COX in part blunts the salutary effects of pGz-CPR. These data suggest that prostaglandins in part are involved in the cardio protection induced by pGz during CPR.
沿脊柱轴的全身周期性加速度（pGz）是一种新型心肺复苏（CPR）方法。仰卧位身体以水平方式的振荡运动在心脏骤停期间为重要器官提供通气和血流，并为血管内皮提供脉动剪切应力。我们之前在猪身上表明，与传统胸外按压心肺复苏相比，pGz-CPR能提供更好的总体生存率、复苏后心肌功能和神经学结果。在整个动物模型和体外制剂中，通过对血管内皮的脉动剪切应力产生的pGz能引发前列腺素和内皮衍生一氧化氮（eNO）的急性生成。与胸外按压心肺复苏相比，pGz-CPR的有益效果部分与内皮衍生一氧化氮有关。eNO和前列腺素在缺血再灌注模型中均具有心脏保护作用。为了区分这些介质的作用，使用非选择性环氧化酶抑制剂（COX）吲哚美辛作为工具，通过生存、心脏保护和局部血流（RBF）的急性结果来研究pGz-CPR期间前列腺素的作用。研究了两组体重25-36kg的麻醉、插管猪。在电诱导心室颤动（VF）之前，动物接受等量的生理盐水安慰剂对照（CONT）（n=9）或吲哚美辛（INDO）（n=8）（2mg/kg）。在无支持的VF持续3分钟后，两组均接受15分钟的pGz-CPR，随后进行药物和电复苏尝试。CONT组和INDO预处理组中循环恢复（ROSC）至3小时的比例分别为78%和63%。两组在基线或实验过程中的血流动力学无统计学显著差异。在基线时，INDO导致脑RBF降低。ROSC后两小时，INDO减弱了脑和心脏的充血反应。在壁运动评分指数（WMSI）方面，INDO组心肌功能障碍的超声心动图证据最为明显。ROSC 3小时后，INDO组和CONT组的肌酸磷酸激酶（CPK）和肌钙蛋白I浓度相差4倍。因此，COX的非特异性急性抑制部分减弱了pGz-CPR的有益效果。这些数据表明，前列腺素部分参与了CPR期间pGz诱导的心脏保护作用。
