Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Resuscitation. 2010 Jan;81(1):93-9. doi: 10.1016/j.resuscitation.2009.09.018. Epub 2009 Nov 18.
The use of emergency cardiopulmonary bypass (ECPB) resuscitation after cardiac arrest may offer hope for survival when standard ACLS therapies fail. However, whether cooling adds benefit to ECPB is unknown and we lack an ECPB rodent model for experimental studies. We sought to (a) develop a 72 h survival rodent model using ECPB to treat asphyxial cardiac arrest and (b) use this new model to evaluate early mild and moderate hypothermia versus normothermia during ECPB resuscitation.
After 8 min of normothermic asphyxia, three groups of rats were resuscitated with ECPB at 37 degrees C (NORM), 34 degrees C (MILD) and 30 degrees C (MOD) for 1h (n=10 each). During the second resuscitation hour, ECPB was discontinued, ventilatory support was provided and body temperatures were maintained at 37 degrees C for NORM, 34 degrees C for MILD, and from 30 degrees C gradually up to 34 degrees C in 1h for MOD animals. From hours 3 to 8, body temperature was maintained at 37 degrees C for NORM and 34 degrees C for MILD and MOD animals.
All rats were initially resuscitated by ECPB. After 72 h, neurological outcome and survival in the MILD (60% survival) and MOD (80%) groups were significantly better than in the NORM (0%) group (p<0.05). Overall performance recovery in the MOD group was best (vs. the NORM group), while the MILD group had an intermediate outcome.
A rodent model of ECPB is feasible and useful for resuscitation studies. The addition of early mild and moderate hypothermia to ECPB resuscitation significantly improves survival compared with normothermic ECPB in rats.
在标准 ACLS 治疗失败的情况下，心脏骤停后使用紧急心肺旁路（ECPB）复苏可能为生存带来希望。然而，冷却是否对 ECPB 有益尚不清楚，并且我们缺乏用于实验研究的 ECPB 啮齿动物模型。我们试图（a）使用 ECPB 治疗窒息性心脏骤停来开发一种 72 小时生存的啮齿动物模型，以及（b）使用这种新模型来评估 ECPB 复苏过程中的早期轻度和中度低温与正常体温。
在正常体温窒息 8 分钟后，三组大鼠分别在 37°C（NORM）、34°C（MILD）和 30°C（MOD）下进行 ECPB 复苏 1 小时（每组 10 只）。在第二个复苏小时期间，停止 ECPB，提供通气支持，并将体温维持在 37°C 用于 NORM、34°C 用于 MILD，并在 1 小时内将 MOD 动物的体温从 30°C 逐渐升高至 34°C。从第 3 小时到第 8 小时，维持 NORM 和 MILD 以及 MOD 动物的体温在 37°C。
所有大鼠最初均通过 ECPB 复苏。72 小时后，MILD（60%存活）和 MOD（80%存活）组的神经功能恢复和存活率明显优于 NORM（0%存活）组（p<0.05）。MOD 组的整体表现恢复最佳（与 NORM 组相比），而 MILD 组的结果则处于中间水平。
ECPB 的啮齿动物模型是可行的，并且对复苏研究有用。与正常体温 ECPB 相比，在 ECPB 复苏中早期轻度和中度低温的添加可显著提高大鼠的存活率。
