在猪和人体尸体转化模型中观察到一致的头高位心肺复苏血流动力学。
Consistent head up cardiopulmonary resuscitation haemodynamics are observed across porcine and human cadaver translational models.
机构信息
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.
出版信息
Resuscitation. 2018 Nov;132:133-139. doi: 10.1016/j.resuscitation.2018.04.009. Epub 2018 Apr 24.
AIM
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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
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。
方法
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。
结果
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。
结论
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。
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