Zoerner F, Lennmyr F, Wiklund L, Martijn C, Semenas E
Department of Surgical Sciences, Section of Anesthesiology and Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden; Department of Operative and Intensive Care Medicine, Hallands Hospital Halmstad, Halmstad, Sweden.
Acta Anaesthesiol Scand. 2015 Apr;59(4):465-74. doi: 10.1111/aas.12480. Epub 2015 Feb 27.
Long-term survival after cardiac arrest (CA) due to shock-refractory ventricular fibrillation (VF) is low. Clearly, there is a need for new pharmacological interventions in the setting of cardiopulmonary resuscitation (CPR) to improve outcome. Here, hemodynamic parameters and cardiac damage are compared between the treatment group (milrinone, esmolol and vasopressin) and controls (vasopressin only) during resuscitation from prolonged CA in piglets.
A total of 26 immature male piglets were subjected to 12-min VF followed by 8-min CPR. The treatment group (n=13) received i.v. (intravenous) boluses vasopressin 0.4 U/kg, esmolol 250 μg/kg and milrinone 25 μg/kg after 13 min, followed by i.v. boluses esmolol 375 μg/kg and milrinone 25 μg/kg after 18 min and continuous esmolol 15 μg/kg/h infusion during 180 min reperfusion, whereas controls (n=13) received equal amounts of vasopressin and saline. A 200 J monophasic counter-shock was delivered to achieve resumption of spontaneous circulation (ROSC) after 8 min CPR. If ROSC was not achieved, another 200 J defibrillation and bolus vasopressin 0.4 U/kg would be administered in both groups. Direct current shocks at 360 J were applied as one shot per minute over maximally 5 min. Hemodynamic variables and troponin I as a marker of cardiac injury were recorded.
Troponin I levels after 180 min reperfusion were lower in the treatment group than in controls (P<0.05). The treatment group received less norepinephrine (P<0.01) and had greater diuresis (P<0.01). There was no difference in survival between groups.
The combination of milrinone, esmolol and vasopressin decreased cardiac injury compared with vasopressin alone.
因顽固性室颤（VF）导致心脏骤停（CA）后的长期生存率较低。显然，在心肺复苏（CPR）过程中需要新的药物干预措施来改善预后。在此，比较了仔猪长时间心脏骤停复苏期间治疗组（米力农、艾司洛尔和血管加压素）和对照组（仅血管加压素）的血流动力学参数和心脏损伤情况。
总共26只未成熟雄性仔猪经历12分钟室颤，随后进行8分钟心肺复苏。治疗组（n = 13）在13分钟后静脉推注血管加压素0.4 U/kg、艾司洛尔250 μg/kg和米力农25 μg/kg，18分钟后静脉推注艾司洛尔375 μg/kg和米力农25 μg/kg，并在180分钟再灌注期间持续静脉输注艾司洛尔15 μg/kg/h，而对照组（n = 13）接受等量的血管加压素和生理盐水。在8分钟心肺复苏后给予200 J单相电击以实现自主循环恢复（ROSC）。如果未实现ROSC，两组均给予另一次200 J除颤和推注血管加压素0.4 U/kg。以每分钟一次的频率施加360 J直流电休克，最长持续5分钟。记录血流动力学变量和作为心脏损伤标志物的肌钙蛋白I。
再灌注180分钟后，治疗组的肌钙蛋白I水平低于对照组（P < 0.05）。治疗组接受的去甲肾上腺素较少（P < 0.01），且尿量更多（P < 0.01）。两组之间的生存率无差异。
与单独使用血管加压素相比，米力农、艾司洛尔和血管加压素联合使用可减轻心脏损伤。
