The Sarver Heart Center at University of Arizona College of Medicine, Tucson, Arizona, USA.
Anesth Analg. 2011 Apr;112(4):884-90. doi: 10.1213/ANE.0b013e31820dc9ec. Epub 2011 Mar 8.
Vasopressors administered IV late during resuscitation efforts fail to improve survival. Intraosseous (IO) access can provide a route for earlier administration. We hypothesized that IO epinephrine after 1 minute of cardiopulmonary resuscitation (CPR) (an "optimal" IO scenario) after 10 minutes of untreated ventricular fibrillation (VF) cardiac arrest would improve outcome in comparison with either IV epinephrine after 8 minutes of CPR (a "realistic" IV scenario) or placebo controls with no epinephrine.
Thirty swine were randomized to IO epinephrine, IV epinephrine, or placebo. Important outcomes included return of spontaneous circulation (ROSC), 24-hour survival, and 24-hour survival with good neurological outcome (cerebral performance category 1).
ROSC after 10 minutes of untreated VF was uncommon without administration of epinephrine (1 of 10), whereas ROSC was nearly universal with IO epinephrine or delayed IV epinephrine (10 of 10 and 9 of 10, respectively; P = 0.001 for either versus placebo). Twenty-four hour survival was substantially more likely after IO epinephrine than after delayed IV epinephrine (10 of 10 vs. 4 of 10, P = 0.001). None of the placebo group survived at 24 hours. Survival with good neurological outcome was more likely after IO epinephrine than after placebo (6 of 10 vs. 0 of 10, P = 0.011), and only 3 of 10 survived with good neurological outcome in the delayed IV epinephrine group (not significant versus either IO or placebo).
In this swine model of prolonged VF cardiac arrest, epinephrine administration during CPR improved outcomes. In addition, early IO epinephrine improved outcomes in comparison with delayed IV epinephrine.
在复苏努力过程中 IV 给予的升压药未能提高存活率。骨内（IO）通路可以提供更早给药的途径。我们假设在未经治疗的心室颤动（VF）心脏骤停 10 分钟后，在心肺复苏（CPR）的第 1 分钟给予 IO 肾上腺素（“最佳”IO 方案），与 CPR 第 8 分钟后给予 IV 肾上腺素（“现实”IV 方案）或无肾上腺素的安慰剂对照相比，将改善结果。
30 头猪被随机分为 IO 肾上腺素组、IV 肾上腺素组或安慰剂组。重要的结果包括自主循环恢复（ROSC）、24 小时存活率和 24 小时存活率伴有良好神经功能结局（脑功能分类 1）。
未经肾上腺素治疗的 VF 10 分钟后，ROSC 并不常见（10 头中只有 1 头），而 IO 肾上腺素或延迟 IV 肾上腺素治疗几乎普遍出现 ROSC（分别为 10 头中的 10 头和 10 头中的 9 头；与安慰剂相比，P = 0.001）。IO 肾上腺素后 24 小时存活率明显高于延迟 IV 肾上腺素（10 头中的 10 头 vs. 4 头中的 10 头，P = 0.001）。安慰剂组无一例在 24 小时内存活。IO 肾上腺素后，神经功能良好的存活率高于安慰剂（10 头中的 6 头 vs. 0 头中的 10 头，P = 0.011），而在延迟 IV 肾上腺素组中，仅有 3 头存活且神经功能良好（与 IO 或安慰剂相比无显著差异）。
在这个长时间 VF 心脏骤停的猪模型中，CPR 期间给予肾上腺素可改善结果。此外，早期 IO 肾上腺素与延迟 IV 肾上腺素相比，改善了结果。
