长时间心脏停搏后的复苏：体外循环和全身高钾血症的作用。

Resuscitation after prolonged cardiac arrest: role of cardiopulmonary bypass and systemic hyperkalemia.

机构信息

Department of Surgery, Division of Cardiothoracic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.

出版信息

Ann Thorac Surg. 2010 Jun;89(6):1972-9. doi: 10.1016/j.athoracsur.2010.02.052.

DOI:10.1016/j.athoracsur.2010.02.052

PMID:20494058

Abstract

BACKGROUND

The purpose of this study was to determine (1) the role of emergency cardiopulmonary bypass (CPB) after prolonged cardiac arrest and failed cardiopulmonary resuscitation, and (2) the use of systemic hyperkalemia during CPB to convert intractable ventricular fibrillation (VF).

METHODS

Thirty-one pigs (34 +/- 2 kg) underwent 15 minutes of cardiac arrest after induced VF, followed by 10 minutes of cardiopulmonary resuscitation-advanced life support. Peripheral CPB was used if cardiopulmonary resuscitation failed to restore stable circulation. Damage was assessed by evaluating hemodynamics, biochemical variables (creatine kinase-MB, neuron-specific enolase), neurologic deficit score, and brain magnetic resonance imaging.

RESULTS

Cardiopulmonary resuscitation alone was successful in only 19% (6 of 31 pigs). Cardiopulmonary bypass was initiated in 81% of animals (25 of 31 pigs) either for hypotension (5 of 25 pigs) or intractable VF (20 of 25 pigs). Defibrillation was successful in 7 of 20 animals during the first 10 minutes after initiating CPB. Ventricular fibrillation persisted more than 10 minutes in 13 of 20 pigs, and animals were treated either with repeated defibrillation (6 of 13 pigs) or with a potassium bolus (7 of 13 pigs) to induce transient cardiac arrest. Overall survival at 24 hours was 84% with cardiopulmonary resuscitation (100% of pigs with hypotension; 71% in CPB-VF < 10 minutes). Despite CPB, fatal myocardial failure occurred after VF duration of more than 10 minutes in all pigs treated with electrical defibrillation, whereas hyperkalemia allowed 100% cardioversion and 86% survival. Biochemical variables remained elevated in all groups. Similarly, severe brain injury was present in all animals as confirmed by neurologic deficit score (197 +/- 10) and magnetic resonance imaging.

CONCLUSIONS

Emergency CPB after prolonged cardiac arrest improves survival and allows systemic hyperkalemia to convert intractable VF, but fails to reduce neurologic damage.

摘要

背景

本研究旨在确定（1）在长时间心脏骤停和心肺复苏失败后使用紧急体外循环（CPB）的作用，以及（2）在 CPB 期间使用全身性高钾血症来转换难治性心室颤动（VF）。

方法

31 头猪（34±2kg）在诱导 VF 后经历 15 分钟的心脏骤停，随后进行 10 分钟的心肺复苏-高级生命支持。如果心肺复苏未能恢复稳定循环，则使用外周 CPB。通过评估血流动力学、生化变量（肌酸激酶-MB、神经元特异性烯醇化酶）、神经缺陷评分和脑磁共振成像来评估损伤。

结果

单独的心肺复苏仅在 19%（31 头猪中的 6 头）的动物中成功。在 81%的动物（31 头猪中的 25 头）中启动了 CPB，要么是因为低血压（25 头猪中的 5 头），要么是因为难治性 VF（25 头猪中的 20 头）。在启动 CPB 后的前 10 分钟内，有 7 头动物中的 20 头动物通过除颤成功。在 20 头猪中的 13 头猪中，VF 持续时间超过 10 分钟，动物接受了重复除颤（13 头猪中的 6 头）或钾弹丸（13 头猪中的 7 头）治疗以诱导短暂的心脏骤停。在心肺复苏时，24 小时的总体存活率为 84%（低血压的猪 100%；CPB-VF < 10 分钟的猪 71%）。尽管进行了 CPB，但在接受电除颤治疗的所有猪中，VF 持续时间超过 10 分钟后，致命性心肌衰竭均会发生，而高钾血症则使 100%的心脏复律和 86%的存活率成为可能。所有组的生化变量均保持升高。同样，所有动物的严重脑损伤均通过神经缺陷评分（197±10）和磁共振成像得到证实。