心肺复苏期间气管插管和喉上气道装置放置对复苏时间内颈动脉血流的影响：一项实验性猪心搏骤停研究。
Effect of endotracheal intubation and supraglottic airway device placement during cardiopulmonary resuscitation on carotid blood flow over resuscitation time: An experimental porcine cardiac arrest study.
机构信息
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Engineering, Seoul National University Hospital, Seoul, Republic of Korea.
出版信息
Resuscitation. 2019 Jun;139:269-274. doi: 10.1016/j.resuscitation.2019.04.020. Epub 2019 Apr 19.
BACKGROUND
Supraglottic airway devices (SGDs) are widely used during the resuscitation of out-of-hospital cardiac arrest (OHCA). The effect of SGDs on carotid blood flow (CBF) as resuscitation time passes is controversial. We assessed the effects of endotracheal intubation (ETI) and 3 types of SGD placement on CBF over time in prolonged resuscitation through an experimental porcine cardiac arrest study.
METHODS
We conducted a randomized crossover study using 12 female pigs. After 4 min of untreated ventricular fibrillation, 3 pairs of ETI for 3 min and each type of SGD placement, including Combitube, I-gel, and laryngeal mask airway, for 3 min were conducted. The order of the 3 pairs of ETI and SGD were randomly assigned for each pig. We measured physiological parameters including CBF and mean arterial pressure (MAP). We compared CBF and MAP between the last 1 min of the insertion period for each of the 3 types of SGD and the preceding ETI period. Trends of CBF and MAP according to ETI and SGD transition were also plotted during the prolonged resuscitation duration.
RESULTS
CBF decreased after inserting I-gel and Combitube compared to ETI (mean difference (95% CI): -685 ml (-1052 to -318) for Combitube, -369 ml (-623 to -114) for I-gel). MAP subsequently decreased after transitioning airway devices as resuscitation was prolonged, regardless of the device type. The mean CBF during the transition from ETI to SGD decreased by -480 ml (95% CI: -675 to -286), but the decrease in CBF during the transition from SGD to ETI was only -4 ml (95% CI: -182 to 175).
CONCLUSION
SGD placement was associated with decreased carotid blood flow during cardiopulmonary resuscitation in an experimental porcine model. As time passed during prolonged resuscitation, reduction in CBF was aggravated after the transition to SGD placement compared to the reduction after the transition to ETI. This study was approved by the study institution IACUC 16-0140-S1A0.
背景
在院外心脏骤停（OHCA）的复苏过程中，广泛使用声门上气道装置（SGD）。随着复苏时间的推移，SGD 对颈动脉血流（CBF）的影响存在争议。我们通过一项实验性猪心搏骤停研究评估了在长时间复苏过程中，气管插管（ETI）和 3 种 SGD 放置方式对 CBF 的影响。
方法
我们使用 12 头雌性猪进行了一项随机交叉研究。在未经治疗的心室颤动 4 分钟后，进行 3 对 ETI（每对持续 3 分钟）和 3 种 SGD 放置（每对持续 3 分钟），包括 Combitube、I-gel 和喉罩气道。每头猪的 3 对 ETI 和 SGD 的顺序随机分配。我们测量了包括 CBF 和平均动脉压（MAP）在内的生理参数。我们比较了 3 种 SGD 插入后最后 1 分钟与前一次 ETI 期间的 CBF 和 MAP。还绘制了在长时间复苏过程中根据 ETI 和 SGD 转换的 CBF 和 MAP 趋势。
结果
与 ETI 相比，插入 I-gel 和 Combitube 后 CBF 降低（Combitube 差值（95%CI）：-685ml（-1052 至-318），I-gel：-369ml（-623 至-114））。随着复苏时间的延长，无论设备类型如何，随后气道设备的转换都会导致 MAP 下降。从 ETI 向 SGD 过渡期间，平均 CBF 下降 480ml（95%CI：-675 至-286），但从 SGD 向 ETI 过渡期间，CBF 下降仅 4ml（95%CI：-182 至 175）。
结论
在实验性猪模型中，SGD 放置与心肺复苏期间颈动脉血流减少有关。在长时间复苏过程中，随着时间的推移，与从 ETI 过渡到 SGD 相比，过渡到 SGD 后 CBF 的减少更为严重。本研究经研究机构 IACUC 16-0140-S1A0 批准。
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