Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.
Scand J Trauma Resusc Emerg Med. 2018 Apr 24;26(1):31. doi: 10.1186/s13049-018-0496-z.
Experimental active compression-decompression (ACD) CPR is associated with increased haemodynamic outcomes compared to standard mechanical chest compressions. Since no clinically available mechanical chest compression device is capable of ACD-CPR, we modified the LUCAS 2 (Physio-Control, Lund, Sweden) to deliver ACD-CPR, hypothesising it would improve haemodynamic outcomes compared with standard LUCAS CPR on pigs with cardiac arrest.
The modified LUCAS delivering 5 cm compressions with or without 2 cm active decompression above anatomical chest level was studied in a randomized crossover design on 19 Norwegian domestic pigs. VF was electrically induced and untreated for 2 min. Each pig received ACD-CPR and standard mechanical CPR in three 180-s. phases. We measured aortic, right atrial, coronary perfusion, intracranial and oesophageal pressure, cerebral and carotid blood flow and cardiac output. Two-sided paired samples t-test was used for continuous parametric data and Wilcoxon test for non-parametric data. P < 0.05 was considered significant.
Due to injuries/device failure, the experimental protocol was completed in nine of 19 pigs. Cardiac output (l/min, median, (25, 75-percentiles): 1.5 (1.1, 1.7) vs. 1.1 (0.8, 1.5), p < 0.01), cerebral blood flow (AU, 297 vs. 253, mean difference: 44, 95% CI; 14-74, p = 0.01), and carotid blood flow (l/min, median, (25, 75-percentiles): 97 (70, 106) vs. 83 (57, 94), p < 0.01) were higher during ACD-CPR compared to standard mechanical CPR. Coronary perfusion pressure (CPP) trended towards higher in end decompression phase.
Cardiac output and brain blood flow improved with mechanical ACD-CPR and CPP trended towards higher during end-diastole compared to standard LUCAS CPR.
与标准机械胸外按压相比，实验性主动按压-释放（ACD）CPR 与更高的血流动力学结果相关。由于没有临床可用的机械胸外按压设备能够实现 ACD-CPR，我们对 LUCAS 2（Physio-Control，Lund，瑞典）进行了修改，以提供 ACD-CPR，假设它将与未经处理的猪心搏骤停相比，与标准 LUCAS CPR 相比，它将改善血流动力学结果。
采用随机交叉设计，在 19 头挪威家猪上研究了可提供 5cm 压缩且在解剖胸部上方可提供 2cm 主动释放的改良 LUCAS，以研究主动释放的效果。VF 通过电诱导，并未经处理 2 分钟。每头猪接受 ACD-CPR 和标准机械 CPR，共三个 180 秒阶段。我们测量了主动脉、右心房、冠状动脉灌注、颅内和食管压力、脑和颈动脉血流以及心输出量。连续参数数据采用双样本配对 t 检验，非参数数据采用 Wilcoxon 检验。p<0.05 被认为具有统计学意义。
由于损伤/设备故障，19 头猪中有 9 头完成了实验方案。心输出量（l/min，中位数，（25%，75%）：1.5（1.1，1.7）比 1.1（0.8，1.5），p<0.01），脑血流（AU，297 比 253，平均差异：44，95%CI；14-74，p=0.01）和颈动脉血流（l/min，中位数，（25%，75%）：97（70，106）比 83（57，94），p<0.01）在 ACD-CPR 期间更高。在舒张末期，冠状动脉灌注压（CPP）有升高趋势。
与标准机械 LUCAS CPR 相比，机械 ACD-CPR 可改善心输出量和脑血流，并且在舒张末期 CPP 有升高趋势。
