Foerster K, D'Inka M, Beyersdorf F, Benk C, Nguyen-Thanh T, Mader I, Fritsch B, Ihling C, Mueller K, Heilmann C, Trummer G
1Heart Center Freiburg University, Freiburg, Germany.
Perfusion. 2013 Nov;28(6):520-8. doi: 10.1177/0267659113495081. Epub 2013 Jul 4.
State-of-the-art cardiopulmonary resuscitation (CPR) restores circulation with inconsistent blood-flow and pressure. Extracorporeal life support (ECLS) following CPR opens the opportunity for "controlled reperfusion". In animal experiments investigating CPR with ECLS, systemic anticoagulation before induced cardiac arrest is normal, but a major point of dispute, since preliminary heparinization in patients undergoing unwitnessed cardiac arrest is impossible. In this study, we investigated options for ECLS after an experimental 15 minutes normothermic cardiac arrest, without preceding anticoagulation, in pigs. Neurological recovery was assessed by a scoring system, electroencephalography and brain magnetic resonance imaging. Additionally, brain histology was performed on day seven after cardiac arrest. We demonstrated that preliminary heparin administration was not necessary for survival or neurological recovery in this setting. Heparin flushing of the cannulae seemed sufficient to avoid thrombus formation. These findings may ease the way to using ECLS in patients with sudden cardiac arrest.
最先进的心肺复苏术（CPR）能恢复血液循环，但血流量和压力并不稳定。心肺复苏术后的体外生命支持（ECLS）为“控制性再灌注”提供了机会。在研究心肺复苏术联合体外生命支持的动物实验中，诱导心脏骤停前的全身抗凝是正常的，但这是一个主要争议点，因为在未被目击的心脏骤停患者中进行初步肝素化是不可能的。在本研究中，我们研究了猪在经历15分钟常温心脏骤停且未进行抗凝预处理后接受体外生命支持的方案。通过评分系统、脑电图和脑磁共振成像评估神经功能恢复情况。此外，在心脏骤停后第7天进行脑组织学检查。我们证明，在这种情况下，初步给予肝素对于生存或神经功能恢复并非必要。对插管进行肝素冲洗似乎足以避免血栓形成。这些发现可能为在心脏骤停患者中使用体外生命支持铺平道路。
