血流动力学导向的心肺复苏可改善脑灌注压和脑组织氧合。
Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation.
作者信息
Friess Stuart H, Sutton Robert M, French Benjamin, Bhalala Utpal, Maltese Matthew R, Naim Maryam Y, Bratinov George, Arciniegas Rodriguez Silvana, Weiland Theodore R, Garuccio Mia, Nadkarni Vinay M, Becker Lance B, Berg Robert A
机构信息
St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, Department of Pediatrics, 660 S. Euclid Avenue, St. Louis, MO 63110, United States.
The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
出版信息
Resuscitation. 2014 Sep;85(9):1298-303. doi: 10.1016/j.resuscitation.2014.05.040. Epub 2014 Jun 16.
AIM
Advances in cardiopulmonary resuscitation (CPR) have focused on the generation and maintenance of adequate myocardial blood flow to optimize the return of spontaneous circulation and survival. Much of the morbidity associated with cardiac arrest survivors can be attributed to global brain hypoxic ischemic injury. The objective of this study was to compare cerebral physiological variables using a hemodynamic directed resuscitation strategy versus an absolute depth-guided approach in a porcine model of ventricular fibrillation (VF) cardiac arrest.
METHODS
Intracranial pressure and brain tissue oxygen tension probes were placed in the frontal cortex prior to induction of VF in 21 female 3-month-old swine. After 7 min of VF, animals were randomized to receive one of three resuscitation strategies: (1) hemodynamic directed care (CPP-20): chest compressions (CCs) with depth titrated to a target systolic blood pressure of 100 mmHg and titration of vasopressors to maintain coronary perfusion pressure (CPP)>20 mmHg; (2) depth 33 mm (D33): target CC depth of 33 mm with standard American Heart Association (AHA) epinephrine dosing; or (3) depth 51 mm (D51): target CC depth of 51 mm with standard AHA epinephrine dosing.
RESULTS
Cerebral perfusion pressures (CerePP) were significantly higher in the CPP-20 group compared to both D33 (p<0.01) and D51 (p=0.046), and higher in survivors compared to non-survivors irrespective of treatment group (p<0.01). Brain tissue oxygen tension was also higher in the CPP-20 group compared to both D33 (p<0.01) and D51 (p=0.013), and higher in survivors compared to non-survivors irrespective of treatment group (p<0.01). Subjects with a CPP>20 mmHg were 2.7 times more likely to have a CerePP>30 mmHg (p<0.001).
CONCLUSIONS
Hemodynamic directed resuscitation strategy targeting coronary perfusion pressure>20 mmHg following VF arrest was associated with higher cerebral perfusion pressures and brain tissue oxygen tensions during CPR.
目的
心肺复苏（CPR）的进展主要集中在产生和维持充足的心肌血流，以优化自主循环恢复和生存几率。心脏骤停幸存者的许多发病情况可归因于全脑缺氧缺血性损伤。本研究的目的是在猪心室颤动（VF）心脏骤停模型中，比较采用血流动力学导向复苏策略与绝对深度导向方法时的脑生理变量。
方法
在21只3个月大的雌性猪诱发VF之前，将颅内压和脑组织氧分压探头置于额叶皮质。VF持续7分钟后，动物被随机分为接受三种复苏策略之一：（1）血流动力学导向治疗（CPP-20）：胸外按压（CCs）深度调整至目标收缩压100 mmHg，并滴定血管加压药以维持冠状动脉灌注压（CPP）>20 mmHg；（2）深度33 mm（D33）：目标CC深度33 mm，采用美国心脏协会（AHA）标准肾上腺素给药；或（3）深度51 mm（D51）：目标CC深度51 mm，采用AHA标准肾上腺素给药。
结果
与D33组（p<0.01）和D51组（p=0.046）相比，CPP-20组的脑灌注压（CerePP）显著更高，且无论治疗组如何，幸存者的CerePP均高于非幸存者（p<0.01）。与D33组（p<0.01）和D51组（p=0.013）相比，CPP-20组的脑组织氧分压也更高，且无论治疗组如何，幸存者的脑组织氧分压均高于非幸存者（p<0.01）。CPP>20 mmHg的受试者CerePP>30 mmHg的可能性高2.7倍（p<0.001）。
结论
VF骤停后以冠状动脉灌注压>20 mmHg为目标的血流动力学导向复苏策略与CPR期间更高的脑灌注压和脑组织氧分压相关。
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