Theochari Evgenia, Xanthos Theodoros, Papadimitriou Dimitrios, Demestiha Theano, Condilis Nicolas, Tsirikos-Karapanos Nikolaos, Tsiftsi Katerina, Papadimitriou Lila
Red Cross Henry Dunant Hospital, Athens, Greece.
Ann Ital Chir. 2008 Nov-Dec;79(6):409-14.
Epinephrine has been the mainstay drug of choice for cardiac resuscitation for more than 30 years. Its vasopressor effects favoring initial resuscitation point to its beta-adrenergic action. However, its beta-adrenergic actions may have detrimental effects. The aim of the present experimental study was to evaluate the efficiency of coadministration of Esmolol, an ultra-short-acting beta-blocker, and of epinephrine in a swine model of cardiac arrest.
Fourteen pigs (19 +/- 2 Kg) were anesthetized and instrumented. Ventricular Fibrillation (VF) was produced electrically. After induction of VF, the animals were left untreated for 5 minutes. Animals were randomized into two groups, control and study group. Six animals were used in the control group, and 8 in the study group. The control group received 10 ml of normal saline via a peripheral vein, while the study group received 0.4 mg/kg Esmolol in 10 ml dilution. Epinephrine was administered to all animals after the first unsuccessful defibrillation set, and all animals received standardized Advanced Life Support.
Seven animals (87.5%) restored cardiac rhythm compatible with a pulse in the Esmolol group, compared to 2 animals (33.3%) in the control group (p = 0.018). The average time until restoration of circulation was 16 +/- 3.2 minutes in our control group and 12.8 +/- 1.4 minutes in Esmolol group (p = 0.059). Coronary perfusion pressure (CPP) was significantly higher in the Esmolol group.
Esmolol improves significantly the outcome of cardiopulmonary resuscitation and the average time of restoration of circulation, while in the proposed dosage does not alter the CPP at the beginning of CPR. However, it augments CPP from the sixth minute of CPR and afterwards.
30多年来，肾上腺素一直是心脏复苏的主要首选药物。其血管加压作用有利于初始复苏，这与其β-肾上腺素能作用有关。然而，其β-肾上腺素能作用可能具有有害影响。本实验研究的目的是评估超短效β受体阻滞剂艾司洛尔与肾上腺素联合应用于猪心脏骤停模型中的效果。
14头猪（体重19±2千克）麻醉后进行仪器植入。通过电刺激诱发室颤（VF）。诱发室颤后，动物不接受治疗5分钟。动物被随机分为两组，即对照组和研究组。对照组6只动物，研究组8只动物。对照组经外周静脉给予10毫升生理盐水，而研究组给予10毫升稀释液中含0.4毫克/千克的艾司洛尔。在首次除颤失败后，所有动物均给予肾上腺素，且所有动物均接受标准化的高级生命支持。
艾司洛尔组7只动物（87.5%）恢复了与脉搏相符的心律，而对照组为2只动物（33.3%）（p = 0.018）。对照组恢复循环的平均时间为16±3.2分钟，艾司洛尔组为12.8±1.4分钟（p = 0.059）。艾司洛尔组的冠状动脉灌注压（CPP）显著更高。
艾司洛尔显著改善了心肺复苏的结果和恢复循环的平均时间，而在所建议的剂量下，在心肺复苏开始时不会改变CPP。然而，它从心肺复苏的第6分钟及之后会增加CPP。
