Ordelman Simone C M A, Aelen Paul, Woerlee Pierre H, van Berkom Paul F J, Scheffer Gert-Jan, Noordergraaf Gerrit J
Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands.
Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands; Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2 (De Wielen), 5612 AZ Eindhoven, The Netherlands.
Resuscitation. 2015 Dec;97:103-8. doi: 10.1016/j.resuscitation.2015.09.378. Epub 2015 Sep 28.
Pulmonary ventilation remains an important part of cardiopulmonary resuscitation, affecting gas exchange and haemodynamics. We designed and studied an improved method of ventilation for CPR, constructed specifically to support both gas exchange and haemodynamics. This method uses continuous insufflation of oxygen at three levels of pressure, resulting in tri-level pressure ventilation (TLPV). We hypothesized that TLPV improves gas exchange and haemodynamics compared to manual gold standard ventilation (GSV).
In 14 pigs, ventricular fibrillation was induced and automated CPR performed for 10 min with either TLPV or GSV. After defibrillation, CPR was repeated with the other ventilation method. Gas exchange and haemodynamics were monitored. Data are presented as mean±standard error of the mean.
TLPV was superior to GSV for PaO2 (163±36 mmHg difference; P=0.001), and peak AWP (-20±2 cmH2O difference; P=0.000) and higher for mean AWP (8±0.2 cmH2O difference; P=0.000). TLPV was comparable to GSV for CPP (5±3 mmHg difference; P=0.012), VCO2 (0.07±0.3 mL/min/kg difference; P=0.001), SvO2 (4±3%-point; P=0.001), mean carotid flow (-0.5±4 mL/min difference; P=0.016), and pHa (0.00±0.03 difference; P=0.002). The PaCO2 data do not provide a conclusive result (4±4 mmHg difference).
We conclude that the ventilation strategy with a tri-level pressure cycle performs comparable to an expert, manual ventilator in an automated-CPR swine model.
肺通气仍是心肺复苏的重要组成部分，影响气体交换和血流动力学。我们设计并研究了一种改进的心肺复苏通气方法，专门构建以支持气体交换和血流动力学。该方法在三个压力水平持续吹入氧气，产生三级压力通气（TLPV）。我们假设与手动金标准通气（GSV）相比，TLPV可改善气体交换和血流动力学。
在14头猪中诱发心室颤动，并使用TLPV或GSV进行10分钟的自动心肺复苏。除颤后，用另一种通气方法重复心肺复苏。监测气体交换和血流动力学。数据以平均值±平均标准误差表示。
在动脉血氧分压方面，TLPV优于GSV（差异为163±36mmHg；P = 0.001），峰值气道压差值为-20±2cmH2O（P = 0.000），平均气道压更高（差异为8±0.2cmH2O；P = 0.000）。在脑灌注压方面，TLPV与GSV相当（差异为5±3mmHg；P = 0.012），二氧化碳排出量（差异为0.07±0.3mL/min/kg；P = 0.001），混合静脉血氧饱和度（差异为4±3个百分点；P = 0.001），平均颈动脉血流（差异为-0.5±4mL/min；P = 0.016），以及动脉血pH值（差异为0.00±0.03；P = 0.002）。动脉血二氧化碳分压数据未提供确凿结果（差异为4±4mmHg）。
我们得出结论，在自动心肺复苏猪模型中，三级压力循环通气策略的表现与专业手动通气器相当。
