Department of Medicine, University of Washington, Seattle, WA, USA.
Resuscitation. 2011 Jul;82(7):925-31. doi: 10.1016/j.resuscitation.2011.02.034. Epub 2011 Apr 8.
Coagulopathy is often present after resuscitation from cardiac arrest but plays an undefined role in the post cardiac arrest syndrome. The aim of this study was to characterize coagulation changes during cardiac arrest and post-resuscitation care in order to direct further focused study.
Ventricular fibrillation (VF) was induced electrically in immature male swine, followed by normothermic American Heart Association Advanced Cardiac Life Support and a uniform post-resuscitation goal-directed resuscitation protocol. PT, aPTT, fibrinogen, Thrombelastography (TEG), platelet contractile force (PCF), clot elastic modulus (CEM), and collagen-induced platelet aggregation were compared at baseline, at 8 min of VF, during the 3rd round of chest compressions (CPR), and at 15, 90, 180, and 360 min after return of circulation using repeated measures ANOVA.
8/18 (44%) animals were resuscitated after 10.9 ± 0.9 min of VF and 7.6 ± 3.4 min of CPR. TEG revealed a significant impairment in clot strength (MA) and clot formation kinetics (K, alpha angle) arising during CPR, followed by a brief prolongation of clot onset times (R) after return of circulation. Both PCF and CEM fell significantly during CPR (PCF by 50%, CEM by 47% of baseline) and platelet aggregation was significantly decreased during CPR. Coagulation changes were partially recovered by 3h of post-resuscitation care.
Whole blood coagulation was rapidly impaired during CPR after electrically induced VF in this swine model by impaired platelet aggregation/contractile function and clotting kinetics. Further platelet-specific study is indicated.
心跳骤停复苏后常发生凝血功能障碍，但在心跳骤停后综合征中作用尚不明确。本研究旨在描述心跳骤停和复苏后期间的凝血变化，以便进一步进行有针对性的研究。
在未成年雄性猪中诱发心室颤动（VF），然后进行常温美国心脏协会高级心脏生命支持和统一的复苏后目标导向复苏方案。在基线、VF 持续 8 分钟、第 3 轮心肺复苏（CPR）期间、循环恢复后 15、90、180 和 360 分钟时，分别比较凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）、纤维蛋白原、血栓弹力图（TEG）、血小板收缩力（PCF）、血凝块弹性模量（CEM）和胶原诱导的血小板聚集。采用重复测量方差分析进行比较。
10.9±0.9 分钟的 VF 和 7.6±3.4 分钟的 CPR 后，有 8/18（44%）只动物复苏成功。TEG 显示，CPR 过程中凝血块强度（MA）和凝血形成动力学（K、α角）明显受损，随后循环恢复后凝血块起始时间（R）短暂延长。CPR 过程中，PCF 和 CEM 均明显下降（PCF 下降 50%，CEM 下降 47%），血小板聚集也明显下降。CPR 后 3 小时，凝血变化部分恢复。
在该猪模型中，电诱导 VF 后 CPR 期间，全血凝血功能迅速受损，原因是血小板聚集/收缩功能和凝血动力学受损。需要进一步进行血小板特异性研究。
