Department of Adult and Pediatric Critical Care Medicine, Safar Center for Resuscitation Research and Vascular Medicine Institute, University of Pittsburgh, United States.
Department of Medicine, Harborview Medical Center, University of Washington, United States.
Resuscitation. 2018 Jan;122:106-112. doi: 10.1016/j.resuscitation.2017.11.055. Epub 2017 Nov 23.
Patients resuscitated from cardiac arrest have brain and cardiac injury. Recent animal studies suggest that the administration of sodium nitrite after resuscitation from 12min of asystole limits acute cardiac dysfunction and improves survival and neurologic outcomes. It has been hypothesized that low doses of IV sodium nitrite given during resuscitation of out of hospital cardiac arrest (OHCA) will improve survival. Low doses of sodium nitrite (e.g., 9.6mg of sodium nitrite) are safe in healthy individuals, however the effect of nitrite on blood pressure in resuscitated cardiac arrest patients is unknown.
We performed a single-center, pilot trial of low dose sodium nitrite (1 or 9.6mg dose) vs. placebo in hospitalized out-of-hospital cardiac arrest patient to determine whether nitrite administration reduced blood pressure and whether whole blood nitrite levels increased in response to nitrite administration.
This is the first reported study of sodium nitrite in cardiac arrest patients. Infusion of low doses of sodium nitrite in comatose survivors of OHCA (n=7) compared to placebo (n=4) had no significant effects on heart rate within 30min after infusion (70±20 vs. 78±3 beats per minute, p=0.18), systolic blood pressure (103±20 vs 108±15mmHg, p=0.3), or methemoglobin levels (0.92±0.33 vs. 0.70±0.26, p=0.45). Serum nitrite levels of 2-4μM were achieved within 15min of a 9.6mg nitrite infusion.
Low dose sodium nitrite does not cause significant hemodynamic effect in patients with OHCA, which suggests that nitrite can be delivered safely in this critically ill patient population. Higher doses of sodium nitrite are necessary in order to achieve target serum level of 10μM.
从心脏骤停中复苏的患者会出现脑和心脏损伤。最近的动物研究表明，在从 12 分钟停搏中复苏后给予亚硝酸钠可限制急性心功能障碍并提高存活率和神经结局。有人假设，在院外心脏骤停（OHCA）复苏期间给予低剂量静脉内亚硝酸钠会提高存活率。在健康个体中，低剂量的亚硝酸钠（例如 9.6mg 亚硝酸钠）是安全的，但是亚硝酸钠对复苏后心脏骤停患者血压的影响尚不清楚。
我们进行了一项单中心、试点试验，比较了低剂量亚硝酸钠（1 或 9.6mg 剂量）与安慰剂在住院 OHCA 患者中的作用，以确定亚硝酸钠给药是否降低血压以及亚硝酸钠给药是否会导致全血亚硝酸盐水平升高。
这是第一项关于心脏骤停患者亚硝酸钠的报告研究。与安慰剂（n=4）相比，在 OHCA 昏迷幸存者中输注低剂量亚硝酸钠（n=7）在输注后 30 分钟内对心率没有明显影响（70±20 与 78±3 次/分钟，p=0.18），收缩压（103±20 与 108±15mmHg，p=0.3）或高铁血红蛋白水平（0.92±0.33 与 0.70±0.26，p=0.45）。在 9.6mg 亚硝酸钠输注后 15 分钟内可达到 2-4μM 的血清亚硝酸盐水平。
低剂量亚硝酸钠不会引起 OHCA 患者的明显血液动力学作用，这表明在这种危重患者人群中可以安全给予亚硝酸钠。需要更高剂量的亚硝酸钠才能达到 10μM 的目标血清水平。
