Gazmuri R J, Weil M H, von Planta M, Gazmuri R R, Shah D M, Rackow E C
Department of Medicine, University of Health Sciences, Chicago Medical School, IL 60064.
J Lab Clin Med. 1991 Jul;118(1):65-73.
After cardiac arrest, return of cardiac function and effective circulation are contingent on prompt restoration of myocardial blood flow. Because conventional closed-chest CPR has limited hemodynamic efficiency, we investigated venoarterial ECC utilizing peripheral vascular access as an alternative for cardiac resuscitation. Ventricular fibrillation was induced in domestic pigs by alternating current delivered to the endocardium of the right ventricle. Conventional closed-chest CPR was begun after 10 minutes. In each instance, precordial compression and external defibrillation failed to restore a viable rhythm. ECC was begun at 15 minutes at an average flow rate of 183 ml/kg/min. In each of eight animals, sinus rhythm was restored. In six of these eight animals, spontaneous circulation was reestablished after an average interval of 152 minutes. When epinephrine was administered concomitantly with ECC in an additional eight animals so as to maintain mean aortic pressure between 60 and 100 mm Hg, sinus rhythm and spontaneous circulation were reestablished in each pig after an average of only 23 minutes. The effects of ECC in conjunction with epinephrine were then compared with those of conventional precordial compression in conjunction with epinephrine (sham ECC). In contrast to ECC, which successfully resuscitated each of five animals, none of five sham ECC-treated animals was resuscitated by continued precordial compression and maximal doses of epinephrine (p less than 0.01). We conclude that ECC in conjunction with epinephrine emerges as a highly effective experimental intervention for resuscitation when conventional techniques of precordial compression and external defibrillation fail to reverse cardiac arrest.
心脏骤停后，心脏功能的恢复和有效循环取决于心肌血流的迅速恢复。由于传统的闭胸心肺复苏术的血流动力学效率有限，我们研究了利用外周血管通路进行静脉-动脉体外循环作为心脏复苏的一种替代方法。通过将交流电施加于右心室心内膜，在家猪中诱发心室颤动。10分钟后开始进行传统的闭胸心肺复苏术。在每种情况下，胸前按压和体外除颤均未能恢复可存活的心律。15分钟时开始进行体外循环，平均流速为183毫升/千克/分钟。在8只动物中的每只动物中，均恢复了窦性心律。在这8只动物中的6只动物中，平均间隔152分钟后恢复了自主循环。在另外8只动物中，在进行体外循环的同时给予肾上腺素，以维持平均主动脉压在60至100毫米汞柱之间，平均仅23分钟后，每只猪均恢复了窦性心律和自主循环。然后将体外循环联合肾上腺素的效果与传统胸前按压联合肾上腺素（假体外循环）的效果进行比较。与成功复苏5只动物中的每只动物的体外循环不同，5只接受假体外循环治疗的动物中，没有一只通过持续的胸前按压和最大剂量的肾上腺素得以复苏（p<0.01）。我们得出结论，当传统的胸前按压和体外除颤技术未能逆转心脏骤停时，体外循环联合肾上腺素成为一种高效的复苏实验性干预措施。
