Aagaard Rasmus, Granfeldt Asger, Bøtker Morten T, Mygind-Klausen Troels, Kirkegaard Hans, Løfgren Bo
1Research Center for Emergency Medicine, Aarhus University Hospital, Denmark. 2Department of Anesthesiology, Randers Regional Hospital, Denmark. 3Department of Anesthesiology and Intensive Care Medicine, Aarhus University Hospital, Denmark. 4Research & Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark. 5Department of Internal Medicine, Randers Regional Hospital, Denmark.
Crit Care Med. 2017 Sep;45(9):e963-e970. doi: 10.1097/CCM.0000000000002464.
Dilation of the right ventricle during cardiac arrest and resuscitation may be inherent to cardiac arrest rather than being associated with certain causes of arrest such as pulmonary embolism. This study aimed to compare right ventricle diameter during resuscitation from cardiac arrest caused by hypovolemia, hyperkalemia, or primary arrhythmia (i.e., ventricular fibrillation).
Thirty pigs were anesthetized and then randomized to cardiac arrest induced by three diffrent methods. Seven minutes of untreated arrest was followed by resuscitation. Cardiac ultrasonographic images were obtained during induction of cardiac arrest, untreated cardiac arrest, and resuscitation. The right ventricle diameter was measured. Primary endpoint was the right ventricular diameter at the third rhythm analysis.
University hospital animal laboratory.
Female crossbred Landrace/Yorkshire/Duroc pigs (27-32 kg).
Pigs were randomly assigned to cardiac arrest caused by either hypovolemia, hyperkalemia, or primary arrhythmia.
At the third rhythm analysis during resuscitation, the right ventricle diameter was 32 mm (95% CI, 29-35) in the hypovolemia group, 29 mm (95% CI, 26-32) in the hyperkalemia group, and 25 mm (95% CI, 22-28) in the primary arrhythmia group. This was larger than baseline for all groups (p = 0.03). When comparing groups at the third rhythm analysis, the right ventricle was larger for hypovolemia than for primary arrhythmia (p < 0.001).
The right ventricle was dilated during resuscitation from cardiac arrest caused by hypovolemia, hyperkalemia, and primary arrhythmia. These findings indicate that right ventricle dilation may be inherent to cardiac arrest, rather than being associated with certain causes of arrest. This contradicts a widespread clinical assumption that in hypovolemic cardiac arrest, the ventricles are collapsed rather than dilated.
心脏骤停和复苏期间右心室扩张可能是心脏骤停所固有的，而非与某些骤停原因（如肺栓塞）相关。本研究旨在比较因低血容量、高钾血症或原发性心律失常（即室颤）导致心脏骤停复苏期间的右心室直径。
30头猪麻醉后随机采用三种不同方法诱导心脏骤停。未经处理的心脏骤停7分钟后进行复苏。在心脏骤停诱导期、未经处理的心脏骤停期和复苏期获取心脏超声图像。测量右心室直径。主要终点是第三次心律分析时的右心室直径。
大学医院动物实验室。
雌性杂交长白/约克夏/杜洛克猪（27 - 32千克）。
猪被随机分配至因低血容量、高钾血症或原发性心律失常导致的心脏骤停组。
在复苏期间的第三次心律分析时，低血容量组右心室直径为32毫米（95%可信区间，29 - 35），高钾血症组为29毫米（95%可信区间，26 - 32），原发性心律失常组为25毫米（95%可信区间，22 - 28）。所有组均大于基线值（p = 0.03）。在第三次心律分析时比较各组，低血容量组的右心室大于原发性心律失常组（p < 0.001）。
因低血容量、高钾血症和原发性心律失常导致心脏骤停复苏期间右心室扩张。这些发现表明右心室扩张可能是心脏骤停所固有的特性，而非与某些骤停原因相关。这与一种广泛存在的临床假设相矛盾，即低血容量性心脏骤停时心室是塌陷而非扩张的。
