Niforopoulou Panagiota, Iacovidou Nicoletta, Lelovas Pavlos, Karlis George, Papalois Αpostolos, Siakavellas Spyros, Spapis Vasileios, Kaparos George, Siafaka Ioanna, Xanthos Theodoros
National and Kapodistrian University of Athens, Medical School, 3A Parou st, Melissia, Athens 15127, Greece.
National and Kapodistrian University of Athens, Medical School, 3 Pavlou Mela st, Athens 16233, Greece.
Am J Emerg Med. 2017 Jun;35(6):846-854. doi: 10.1016/j.ajem.2017.01.040. Epub 2017 Jan 23.
To assess whether use of Impedance Threshold Device (ITD) during cardiopulmonary resuscitation (CPR) reduces the degree of post-cardiac arrest Acute Kidney Injury (AKI), as a result of improved hemodynamics, in a porcine model of ventricular fibrillation (VF) cardiac arrest.
After 8 min of untreated cardiac arrest, the animals were resuscitated either with active compression-decompression (ACD) CPR plus a sham ITD (control group, n=8) or with ACD-CPR plus an active ITD (ITD group, n=8). Adrenaline was administered every 4 min and electrical defibrillation was attempted every 2 min until return of spontaneous circulation (ROSC) or asystole. After ROSC the animals were monitored for 6 h under general anesthesia and then returned to their cages for a 48 h observation, before euthanasia. Two novel biomarkers, Neutrophil Gelatinase-Associated Lipocalin (NGAL) in plasma and Interleukin-18 (IL-18) in urine, were measured at 2 h, 4 h, 6 h, 24 h and 48 h post-ROSC, in order to assess the degree of AKI.
ROSC was observed in 7 (87.5%) animals treated with the sham valve and 8 (100%) animals treated with the active valve (P=NS). However, more than twice as many animals survived at 48 h in the ITD group (n=8, 100%) compared to the control group (n=3, 37.5%). Urine IL-18 and plasma NGAL levels were augmented post-ROSC in both groups, but they were significantly higher in the control group compared with the ITD group, at all measured time points.
Use of ITD during ACD-CPR improved hemodynamic parameters, increased 48 h survival and decreased the degree of post-cardiac arrest AKI in the resuscitated animals.
在猪心室颤动（VF）心脏骤停模型中，评估心肺复苏（CPR）期间使用阻抗阈值装置（ITD）是否因改善血流动力学而降低心脏骤停后急性肾损伤（AKI）的程度。
在未经处理的心脏骤停8分钟后，动物分别接受主动按压-减压（ACD）CPR加假ITD（对照组，n = 8）或ACD-CPR加活性ITD（ITD组，n = 8）进行复苏。每4分钟给予肾上腺素，每2分钟尝试进行电除颤，直至自主循环恢复（ROSC）或心脏停搏。ROSC后，动物在全身麻醉下监测6小时，然后放回笼中进行48小时观察，之后实施安乐死。在ROSC后2小时、4小时、6小时、24小时和48小时测量两种新型生物标志物，即血浆中的中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和尿液中的白细胞介素-18（IL-18），以评估AKI的程度。
接受假瓣膜治疗的7只（87.5%）动物和接受活性瓣膜治疗的8只（100%）动物观察到ROSC（P = 无显著性差异）。然而，ITD组在48小时存活的动物数量（n = 8，100%）是对照组（n = 3，37.5%）的两倍多。两组ROSC后尿液IL-18和血浆NGAL水平均升高，但在所有测量时间点，对照组均显著高于ITD组。
在ACD-CPR期间使用ITD可改善血流动力学参数，提高48小时生存率，并降低复苏动物心脏骤停后AKI的程度。
