冠状动脉灌注压与长时间心脏停搏后的自主循环恢复。
Coronary perfusion pressure and return of spontaneous circulation after prolonged cardiac arrest.
机构信息
Department of Emergency Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
出版信息
Prehosp Emerg Care. 2010 Jan-Mar;14(1):78-84. doi: 10.3109/10903120903349796.
INTRODUCTION
The amount of myocardial perfusion required for successful defibrillation after prolonged cardiac arrest is not known. Coronary perfusion pressure (CPP) is a surrogate for myocardial perfusion. One limited clinical study reported that a threshold of 15 mmHg was necessary for return of spontaneous circulation (ROSC), and that CPP was predictive of ROSC. A distinction between threshold and dose of CPP has not been reported.
OBJECTIVE
To test the hypothesis that swine achieving ROSC will have higher preshock mean CPP and higher preshock area under the CPP curve (AUC) than swine not attaining ROSC.
METHODS
Data from four similar swine cardiac arrest studies were retrospectively pooled. Animals had undergone 8-11 minutes of untreated ventricular fibrillation, 2 minutes of mechanical cardiopulmonary resuscitation (CPR), administration of drugs, and 3 more minutes of CPR prior to the first shock. Mean CPP +/- standard error of the mean (SEM) was derived from the last 20 compressions of each 30-second epoch of CPR and compared between ROSC/no-ROSC groups by repeated-measures analysis of variance (RM-ANOVA). AUC for all compressions delivered over the 5 minutes was calculated by direct summation and compared by Kruskal-Wallis test. Prediction of ROSC was assessed by logistic regression.
RESULTS
Throughout the first 5 minutes of CPR (n = 80), mean CPP +/- SEM was consistently higher in animals with ROSC (n = 63) (maximum CPP 41.2 +/- 0.6 mmHg) than animals with no ROSC (maximum CPP 20.1 +/- 0.3 mmHg) (p = 0.0001). Animals with ROSC received more total reperfusion (43.9 +/- 17.6 mmHg x 10(2)) than animals without ROSC (21.4 +/- 13.7 mmHg x 10(2)) (p < 0.001). Two regression models identified CPP (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.05, 1.18) and AUC (OR 1.10; 95% CI 1.05, 1.16) as predictors of ROSC. Experimental study also predicted ROSC in each model (OR 1.70; 95% CI 1.15, 2.50; and OR 1.59; 95% CI 1.12, 2.25, respectively).
CONCLUSION
Higher CPP threshold and dose are associated with and predictive of ROSC.
简介
在长时间心脏骤停后，成功除颤所需的心肌灌注量尚不清楚。冠脉灌注压（CPP）是心肌灌注的替代指标。一项有限的临床研究报告称，自主循环恢复（ROSC）需要 15mmHg 的阈值，并且 CPP 可预测 ROSC。尚未报道 CPP 阈值和剂量之间的区别。
目的
检验如下假设，即达到 ROSC 的猪的平均预激 CPP 和预激 CPP 曲线下面积（AUC）高于未达到 ROSC 的猪。
方法
回顾性汇总了四项类似的猪心搏骤停研究的数据。动物经历了 8-11 分钟未经治疗的心室颤动、2 分钟机械心肺复苏（CPR）、药物给药和 3 分钟 CPR 后，在第一次电击前进行。从每个 30 秒 CPR 时相的最后 20 次压缩中得出平均 CPP +/- 均数标准误差（SEM），并通过重复测量方差分析（RM-ANOVA）比较 ROSC/no-ROSC 组之间的差异。通过直接求和计算 5 分钟内所有压缩的 AUC，并通过 Kruskal-Wallis 检验进行比较。通过逻辑回归评估 ROSC 的预测。
结果
在整个 CPR 的前 5 分钟（n=80），ROSC 动物（n=63）（最大 CPP 41.2 +/- 0.6mmHg）的平均 CPP +/- SEM 始终高于无 ROSC 动物（最大 CPP 20.1 +/- 0.3mmHg）（p=0.0001）。达到 ROSC 的动物接受了更多的总再灌注（43.9 +/- 17.6mmHg x 10(2)），而未达到 ROSC 的动物（21.4 +/- 13.7mmHg x 10(2)）（p < 0.001）。两个回归模型确定 CPP（优势比 [OR] 1.11；95%置信区间 [CI] 1.05, 1.18）和 AUC（OR 1.10；95% CI 1.05, 1.16）是 ROSC 的预测因素。实验研究还分别在每个模型中预测了 ROSC（OR 1.70；95% CI 1.15, 2.50；和 OR 1.59；95% CI 1.12, 2.25）。
结论
更高的 CPP 阈值和剂量与 ROSC 相关，并可预测 ROSC。
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