呼气末二氧化碳指导下的胸外按压传递可提高新生儿窒息性心跳骤停模型的存活率。
End-Tidal CO2-Guided Chest Compression Delivery Improves Survival in a Neonatal Asphyxial Cardiac Arrest Model.
机构信息
1Department of Pediatric Anesthesiology and Pain Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR. 2Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, The Children's Hospital of San Antonio, San Antonio, TX. 3Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 4Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. 5Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, MD.
出版信息
Pediatr Crit Care Med. 2017 Nov;18(11):e575-e584. doi: 10.1097/PCC.0000000000001299.
OBJECTIVES
To determine whether end-tidal CO2-guided chest compression delivery improves survival over standard cardiopulmonary resuscitation after prolonged asphyxial arrest.
DESIGN
Preclinical randomized controlled study.
SETTING
University animal research laboratory.
SUBJECTS
1-2-week-old swine.
INTERVENTIONS
After undergoing a 20-minute asphyxial arrest, animals received either standard or end-tidal CO2-guided cardiopulmonary resuscitation. In the standard group, chest compression delivery was optimized by video and verbal feedback to maintain the rate, depth, and release within published guidelines. In the end-tidal CO2-guided group, chest compression rate and depth were adjusted to obtain a maximal end-tidal CO2 level without other feedback. Cardiopulmonary resuscitation included 10 minutes of basic life support followed by advanced life support for 10 minutes or until return of spontaneous circulation.
MEASUREMENTS AND MAIN RESULTS
Mean end-tidal CO2 at 10 minutes of cardiopulmonary resuscitation was 34 ± 8 torr in the end-tidal CO2 group (n = 14) and 19 ± 9 torr in the standard group (n = 14; p = 0.0001). The return of spontaneous circulation rate was 7 of 14 (50%) in the end-tidal CO2 group and 2 of 14 (14%) in the standard group (p = 0.04). The chest compression rate averaged 143 ± 10/min in the end-tidal CO2 group and 102 ± 2/min in the standard group (p < 0.0001). Neither asphyxia-related hypercarbia nor epinephrine administration confounded the use of end-tidal CO2-guided chest compression delivery. The response of the relaxation arterial pressure and cerebral perfusion pressure to the initial epinephrine administration was greater in the end-tidal CO2 group than in the standard group (p = 0.01 and p = 0.03, respectively). The prevalence of resuscitation-related injuries was similar between groups.
CONCLUSIONS
End-tidal CO2-guided chest compression delivery is an effective resuscitation method that improves early survival after prolonged asphyxial arrest in this neonatal piglet model. Optimizing end-tidal CO2 levels during cardiopulmonary resuscitation required that chest compression delivery rate exceed current guidelines. The use of physiologic feedback during cardiopulmonary resuscitation has the potential to provide optimized and individualized resuscitative efforts.
目的
确定在长时间窒息性心脏骤停后，呼气末二氧化碳指导的胸外按压输送是否比标准心肺复苏更能提高生存率。
设计
临床前随机对照研究。
地点
大学动物研究实验室。
对象
1-2 周大的猪。
干预措施
动物经历 20 分钟窒息性心脏骤停后，接受标准或呼气末二氧化碳指导的心肺复苏。在标准组中，通过视频和口头反馈来优化胸外按压输送，以维持率、深度和释放符合已发表指南。在呼气末二氧化碳指导组中，调整胸外按压率和深度以获得最大呼气末二氧化碳水平，而无需其他反馈。心肺复苏包括 10 分钟的基础生命支持，然后是 10 分钟的高级生命支持，或直到自主循环恢复。
测量和主要结果
心肺复苏 10 分钟时的平均呼气末二氧化碳在呼气末二氧化碳组为 34±8 毫托（n=14），在标准组为 19±9 毫托（n=14；p=0.0001）。在呼气末二氧化碳组中，自主循环恢复率为 7 例（50%），在标准组中为 2 例（14%）（p=0.04）。呼气末二氧化碳组的胸外按压率平均为 143±10 次/分钟，标准组为 102±2 次/分钟（p<0.0001）。与窒息相关的高碳酸血症和肾上腺素的给予都没有混淆呼气末二氧化碳指导的胸外按压输送的使用。与标准组相比，呼气末二氧化碳组对初始肾上腺素给药的松弛动脉压和脑灌注压的反应更大（p=0.01 和 p=0.03）。复苏相关损伤的发生率在两组之间相似。
结论
在这个新生仔猪模型中，呼气末二氧化碳指导的胸外按压输送是一种有效的复苏方法，可以提高长时间窒息性心脏骤停后的早期生存率。在心肺复苏期间优化呼气末二氧化碳水平需要使胸外按压输送率超过当前指南。在心肺复苏期间使用生理反馈有可能提供优化和个体化的复苏努力。
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