Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
Department of Emergency Medicine, University of Tennessee, Memphis, Medical Director, Memphis Fire Department and State of Tennessee, USA.
Resuscitation. 2018 Nov;132:133-139. doi: 10.1016/j.resuscitation.2018.04.009. Epub 2018 Apr 24.
The objectives were: 1) replicate key elements of Head Up (HUP) cardiopulmonary resuscitation (CPR) physiology in a traditional swine model of ventricular fibrillation (VF), 2) compare HUP CPR physiology in pig cadavers (PC) to the VF model 3) develop a new human cadaver (HC) CPR model, and 4) assess HUP CPR in HC.
Nine female pigs were intubated, and anesthetized. Venous, arterial, and intracranial access were obtained. After 6 min of VF, CPR was performed for 2 min epochs as follows: Standard (S)-CPR supine (SUP), Active compression decompression (ACD) CPR + impedance threshold device (ITD-16) CPR SUP, then ACD + ITD HUP CPR. The same sequence was performed in PC 3 h later. In 9 HC, similar vascular and intracranial access were obtained and CPR performed for 1 min epochs using the same sequence as above.
The mean cerebral perfusion pressure (CerPP, mmHg) was 14.5 ± 6 for ACD + ITD SUP and 28.7 ± 10 for ACD + ITD HUP (p = .007) in VF, -3.6 ± 5 for ACD + ITD SUP and 7.8 ± 9 for ACD + ITD HUP (p = .007) in PC, and 1.3 ± 4 for ACD + ITD SUP and 11.3 ± 5 for ACD + ITD HUP (p = .007) in HC. Mean systolic and diastolic intracranial pressures (ICP) (mmHg) were significantly lower in the ACD + ITD HUP group versus the ACD + ITD SUP group in all three CPR models.
HUP CPR decreased ICP while increasing CerPP in pigs in VF as well as in PC and HC CPR models. This first-time demonstration of HUP CPR physiology in humans provides important implications for future resuscitation research and treatment.
目的是：1）在传统的心室颤动（VF）猪模型中复制头高（HUP）心肺复苏（CPR）生理学的关键要素，2）比较猪尸体（PC）中的 HUP CPR 生理学与 VF 模型，3）开发新的人体尸体（HC）CPR 模型，4）评估 HC 中的 HUP CPR。
将 9 只雌性猪进行插管，并进行麻醉。获得静脉、动脉和颅内通路。在 VF 后 6 分钟，CPR 以 2 分钟的时段进行，如下所示：标准（S）-CPR 仰卧位（SUP）、主动压缩减压（ACD）CPR+阻抗阈值设备（ITD-16）CPR SUP，然后 ACD+ITD HUP CPR。3 小时后在 PC 上执行相同的序列。在 9 名 HC 中，获得类似的血管和颅内通路，并使用上述相同的序列进行 1 分钟的 CPR。
VF 中的平均脑灌注压（CerPP，mmHg）为 ACD+ITD SUP 为 14.5±6，ACD+ITD HUP 为 28.7±10（p=0.007），PC 中的 ACD+ITD SUP 为-3.6±5，ACD+ITD HUP 为 7.8±9（p=0.007），HC 中的 ACD+ITD SUP 为 1.3±4，ACD+ITD HUP 为 11.3±5（p=0.007）。所有三种 CPR 模型中，ACD+ITD HUP 组的平均收缩压和舒张压颅内压（ICP）（mmHg）均明显低于 ACD+ITD SUP 组。
在 VF 以及 PC 和 HC CPR 模型中，HUP CPR 降低 ICP 同时增加 CerPP。这是首次在人体中展示 HUP CPR 生理学，为未来的复苏研究和治疗提供了重要启示。
