Trummer Georg, Benk Christoph, Beyersdorf Friedhelm
Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.
Faculty of Medicine, University of Freiburg, Freiburg, Germany.
J Thorac Dis. 2019 Jun;11(Suppl 10):S1464-S1470. doi: 10.21037/jtd.2019.04.05.
Sudden circulatory arrest (CA) requiring cardiopulmonary resuscitation (CPR) has for decades been associated with high mortality and frequent neurological sequelae in the rarer survivors. The high mortality and morbidity are potentially related to a severe and global ischemia/reperfusion injury (IRI) of the whole body, especially the brain. Consequently, strategies to counteract this severe IRI may improve survival and neurological recovery of affected patients.
Based on the target to limit IRI in single organs, suitable parameters and methods were composed to form a global treatment concept, the CARL method (controlled automated reperfusion of the whole body). The concept centers on extracorporeal circulation, enhanced with readily available online monitoring. It allows for targeted adaption of different parameters (i.e., blood pressure and flow, temperature, oxygen content, electrolytes) during the reperfusion process, in the sense of a controlled reperfusion. Parameters and elements of the CARL method were extensively tested in a chronic animal model. An appropriate medical device, the system configuration "CIRD 1.0" (Controlled Integrated Resuscitation Device) is approved to be applied to patients.
A set of parameters that support a limitation of a global IRI have been identified in over 250 animal experiments. Their specific targets and surveillance using adequate monitoring features are described. Using the CIRD in a single center, 14 patients with witnessed, but extremely prolonged CPR (51-120 minutes) have been treated with CARL. The outcome of these patients was favorable, with 7 of 14 patients regaining full consciousness and 6 of 7 allocated to Cerebral Performance Class (CPC) "1".
CA followed by CPR is associated with a very high mortality and frequent neurological sequelae. Limiting the occurring severe and global IRI may be a key to an improved survival and neurological recovery. Therefore, the therapeutic approach of CARL, which stands for a personalized, comprehensive therapy based on a readily available set of monitoring data and diagnostic findings, has been developed. First experience in patients indicates beneficial effects that call for further studies in the field of CARL.
数十年来，需要进行心肺复苏（CPR）的突发循环骤停（CA）一直与罕见幸存者的高死亡率和频繁的神经后遗症相关。高死亡率和高发病率可能与全身尤其是大脑的严重全身性缺血/再灌注损伤（IRI）有关。因此，对抗这种严重IRI的策略可能会改善受影响患者的生存率和神经功能恢复情况。
基于限制单一器官IRI的目标，组合了合适的参数和方法，形成了一种整体治疗概念，即CARL方法（全身控制性自动再灌注）。该概念以体外循环为核心，并通过易于获得的在线监测进行强化。它允许在再灌注过程中针对不同参数（即血压和血流量、温度、氧含量、电解质）进行有针对性的调整，实现控制性再灌注。CARL方法的参数和要素在慢性动物模型中进行了广泛测试。一种合适的医疗设备，即系统配置“CIRD 1.0”（控制性综合复苏设备）已获批应用于患者。
在250多次动物实验中确定了一组有助于限制全身性IRI的参数。描述了它们的具体目标以及使用适当监测功能进行的监测情况。在单一中心使用CIRD，对14例有目击但心肺复苏时间极长（51 - 120分钟）的患者采用CARL方法进行了治疗。这些患者的预后良好，14例患者中有7例恢复了完全意识，7例中有6例被评定为脑功能分级（CPC）“1”级。
心脏骤停后进行心肺复苏与极高的死亡率和频繁的神经后遗症相关。限制发生的严重全身性IRI可能是提高生存率和神经功能恢复的关键。因此，已开发出CARL治疗方法，它代表基于易于获得的一组监测数据和诊断结果的个性化、综合治疗。在患者中的初步经验表明其具有有益效果，这需要在CARL领域进行进一步研究。
