FinnHEMS Research and Development Unit, Lentäjäntie 3, 01530, Vantaa, Finland; Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, PL 340, 00029 HUS, Helsinki, Finland; Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, PL 340, 00029 HUS, Finland.
Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, PL 340, 00029 HUS, Helsinki, Finland.
Resuscitation. 2019 Apr;137:124-132. doi: 10.1016/j.resuscitation.2019.02.014. Epub 2019 Feb 20.
Screening and correcting reversible causes of cardiac arrest (CA) are an essential part of cardiopulmonary resuscitation (CPR). Point-of-care (POC) laboratory analyses are used for screening pre-arrest pathologies, such as electrolyte disorders and acid-base balance disturbances. The aims of this study were to compare the intraosseous (IO), arterial and central venous POC values during CA and CPR and to see how the CPR values reflect the pre-arrest state.
We performed an experimental study on 23 anaesthetised pigs. After induction of ventricular fibrillation (VF), we obtained POC samples from the IO space, artery and central vein simultaneously at three consecutive time points. We observed the development of the values during CA and CPR and compared the CPR values to the pre-arrest values.
The IO, arterial and venous values changed differently from one another during the course of CA and CPR. Base excess and pH decreased in the venous and IO samples during untreated VF, but in the arterial samples, this only occurred after the onset of CPR. The IO, arterial and venous potassium values were higher during CPR compared to the pre-arrest arterial values (mean elevations 4.4 mmol/l (SD 0.72), 3.3 mmol/l (0.78) and 2.8 mmol/l (0.94), respectively).
A dynamic change occurs in the common laboratory values during CA and CPR. POC analyses of lactate, pH, sodium and calcium within IO samples are not different from analyses of arterial or venous blood. Potassium values in IO, arterial and venous samples during CPR are higher than the pre-arrest arterial values.
筛查和纠正心脏骤停（CA）的可逆原因是心肺复苏（CPR）的重要组成部分。床边（POC）实验室分析用于筛查术前病理，如电解质紊乱和酸碱平衡紊乱。本研究的目的是比较 CA 和 CPR 期间的骨内（IO）、动脉和中心静脉 POC 值，并观察 CPR 值如何反映术前状态。
我们对 23 头麻醉猪进行了一项实验研究。在诱导心室颤动（VF）后，我们同时从 IO 空间、动脉和中心静脉获得三个连续时间点的 POC 样本。我们观察了 CA 和 CPR 过程中值的变化，并将 CPR 值与术前值进行了比较。
在 CA 和 CPR 过程中，IO、动脉和静脉值彼此之间的变化不同。在未经治疗的 VF 期间，静脉和 IO 样本中的碱剩余和 pH 值降低，但在动脉样本中，仅在 CPR 开始后才发生这种情况。与术前动脉值相比，CPR 期间 IO、动脉和静脉钾值升高（平均升高分别为 4.4mmol/l（0.72）、3.3mmol/l（0.78）和 2.8mmol/l（0.94））。
CA 和 CPR 期间常见实验室值会发生动态变化。IO 样本中乳酸、pH 值、钠和钙的 POC 分析与动脉或静脉血的分析没有区别。CPR 期间 IO、动脉和静脉样本中的钾值高于术前动脉值。
