Department of Experimental Surgery and Surgical Research, University of Athens, Medical School, 11 527 Athens, Greece.
Am J Emerg Med. 2012 Oct;30(8):1549-54. doi: 10.1016/j.ajem.2012.01.008. Epub 2012 Mar 3.
The aim of the present study was to assess whether the combination of epinephrine, vasopressin, and nitroglycerin would improve initial resuscitation success, 24-hour survival, and neurologic outcome compared with epinephrine alone in a swine model of asphyxial cardiac arrest (CA).
This prospective randomized experimental study was conducted at a laboratory research department. Twenty male Landrace/Large-White pigs 12 to 15 weeks of age were investigated. Asphyxial CA was induced by occlusion of the endotracheal tube. Pigs remained untreated for 4 minutes before attempting resuscitation by unclamping the endotracheal tube, mechanical ventilation, chest compressions, and epinephrine (group E) or a combination of epinephrine with vasopressin and nitroglycerin (group EVN) administered intravenously. In case of restoration of spontaneous circulation, the animals were supported for 30 minutes and then observed for 24 hours.
Coronary perfusion pressure and mean arterial pressure were significantly increased during cardiopulmonary resuscitation in group EVN. In both groups, restoration of spontaneous circulation and survival rates were comparable (P value, nonsignificant). At 24 hours after CA, neurologic deficit score was significantly better in animals treated with the combination pharmacotherapy (P < .001). Brain histologic damage score was also higher in group EVN compared with group E (P < .001). Total histologic damage score and neurologic deficit score showed a statistical significant correlation (P < .001).
In this porcine model of asphyxial CA, the addition of nitroglycerin to vasopressin and epinephrine maintained elevated coronary perfusion pressure during asphyxia CA and resulted in significantly better neurologic and histopathologic outcome in comparison with epinephrine alone.
本研究旨在评估在窒息性心脏骤停（CA）猪模型中，与单独使用肾上腺素相比，肾上腺素、血管加压素和硝酸甘油联合使用是否会提高初始复苏成功率、24 小时生存率和神经功能结局。
这是一项在实验室研究部门进行的前瞻性随机实验研究。研究纳入了 20 只 12 至 15 周龄的雄性长白/大白种猪。通过阻塞气管内导管来诱导窒息性 CA。在尝试通过松开气管内导管、机械通气、胸部按压和静脉内给予肾上腺素（E 组）或肾上腺素联合血管加压素和硝酸甘油（EVN 组）来进行复苏之前，猪会先不进行任何处理，持续 4 分钟。如果自主循环恢复，则对动物进行 30 分钟的支持，然后观察 24 小时。
EVN 组心肺复苏期间冠状动脉灌注压和平均动脉压显著升高。在两组中，自主循环恢复和生存率相当（P 值，无统计学意义）。在 CA 后 24 小时，接受联合药物治疗的动物的神经功能缺损评分明显更好（P<0.001）。与 E 组相比，EVN 组的脑组织学损伤评分也更高（P<0.001）。总组织学损伤评分和神经功能缺损评分呈显著相关（P<0.001）。
在该窒息性 CA 猪模型中，与单独使用肾上腺素相比，血管加压素和肾上腺素联合使用硝酸甘油可在窒息性 CA 期间维持较高的冠状动脉灌注压，并导致与单独使用肾上腺素相比，神经功能和组织病理学结局显著改善。
