Cardiovascular Division at The University of Minnesota, MN, United States.
Resuscitation. 2013 Aug;84(8):1143-9. doi: 10.1016/j.resuscitation.2013.01.024. Epub 2013 Jan 29.
We investigated the effects of ischemic postconditioning (IPC) with and without cardioprotective vasodilatory therapy (CVT) at the initiation of cardiopulmonary resuscitation (CPR) on cardio-cerebral function and 48-h survival.
Prospective randomized animal study. Following 15 min of ventricular fibrillation, 42 Yorkshire farm pigs weighing an average of 34 ± 2 kg were randomized to receive standard CPR (SCPR, n=12), SCPR+IPC (n=10), SCPR+IPC+CVT (n=10), or SCPR+CVT (n=10). IPC was delivered during the first 3 min of CPR with 4 cycles of 20s of chest compressions followed by 20-s pauses. CVT consisted of intravenous sodium nitroprusside (2mg) and adenosine (24 mg) during the first minute of CPR. Epinephrine was given in all groups per standard protocol. A transthoracic echocardiogram was obtained on all survivors 1 and 4h post-ROSC. The brains were extracted after euthanasia at least 24h later to assess ischemic injury in 7 regions. Ischemic injury was graded on a 0-4 scale with (0=no injury to 4 ≥ 50% neural injury). The sum of the regional scores was reported as cerebral histological score (CHS). 48 h survival was reported.
Post-resuscitation left ventricular ejection (LVEF) fraction improved in SCPR+CVT, SCPR+IPC+CVT and SCPR+IPC groups compared to SCPR (59% ± 9%, 52% ± 14%, 52% ± 14% vs. 35% ± 11%, respectively, p<0.05). Only SCPR+IPC and SCPR+IPC+CVT, but not SCPR+CVT, had lower mean CHS compared to SCPR (5.8 ± 2.6, 2.8 ± 1.8 vs. 10 ± 2.1, respectively, p<0.01). The 48-h survival among SCPR+IPC, SCPR+CVT, SCPR+IPC+CVT and SCPR was 6/10, 3/10, 5/10 and 1/12, respectively (Cox regression p<0.01).
IPC and CVT during standard CPR improved post-resuscitation LVEF but only IPC was independently neuroprotective and improved 48-h survival after 15 min of untreated cardiac arrest in pigs.
本研究旨在探讨心肺复苏（CPR）开始时，缺血后处理（IPC）联合和不联合心脏保护性血管扩张疗法（CVT）对心脑功能和 48 小时存活率的影响。
这是一项前瞻性随机动物研究。在心室颤动 15 分钟后，42 头平均体重为 34±2kg 的约克郡农场猪被随机分为接受标准心肺复苏（SCPR，n=12）、SCPR+IPC（n=10）、SCPR+IPC+CVT（n=10）或 SCPR+CVT（n=10）组。IPC 在 CPR 的前 3 分钟内进行，每 20 秒进行一次胸部按压，然后暂停 20 秒。CVT 在 CPR 的第 1 分钟内给予静脉注射硝普钠（2mg）和腺苷（24mg）。所有组均按照标准方案给予肾上腺素。所有幸存者在自主循环恢复（ROSC）后 1 小时和 4 小时进行经胸超声心动图检查。至少在 24 小时后安乐死提取大脑，以评估 7 个区域的缺血损伤。采用 0-4 级评分评估缺血损伤（0 级：无损伤；4 级：≥50%神经损伤）。报告区域评分总和作为脑组织学评分（CHS）。报告 48 小时存活率。
与 SCPR 组相比，SCPR+CVT、SCPR+IPC+CVT 和 SCPR+IPC 组复苏后左心室射血分数（LVEF）均有改善（分别为 59%±9%、52%±14%和 52%±14%，p<0.05）。只有 SCPR+IPC 和 SCPR+IPC+CVT 组，而不是 SCPR+CVT 组，与 SCPR 组相比，平均 CHS 较低（分别为 5.8±2.6、2.8±1.8 与 10±2.1，p<0.01）。SCPR+IPC、SCPR+CVT、SCPR+IPC+CVT 和 SCPR 组的 48 小时存活率分别为 6/10、3/10、5/10 和 1/12（Cox 回归，p<0.01）。
在标准 CPR 中联合应用 IPC 和 CVT 可改善复苏后 LVEF，但只有 IPC 具有独立的神经保护作用，并可提高未经治疗的 15 分钟心脏骤停后猪的 48 小时存活率。
