肱骨骨髓腔内注射肾上腺素对小儿失血性心脏骤停猪模型的影响。

Effects of humeral intraosseous epinephrine in a pediatric hypovolemic cardiac arrest porcine model.

作者信息

Neill Michael James, Burgert James M, Blouin Dawn, Tigges Benjamin, Rodden Kari, Roberts Rachel, Anderson Phillip, Hallquist Travis, Navarro John, O'Sullivan Joseph, Johnson Don

机构信息

US Army Graduate Program in Anesthesia Nursing, US Army Medical Department, Fort Sam Houston, Texas, USA.

Department of Continuing EducationEvidence-based Healthcare Program, University of Oxford Kellogg College, Oxford, Oxfordshire, UK.

出版信息

Trauma Surg Acute Care Open. 2020 Feb 18;5(1):e000372. doi: 10.1136/tsaco-2019-000372. eCollection 2020.

DOI:10.1136/tsaco-2019-000372

PMID:32154374

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7046964/

Abstract

BACKGROUND

Aims of the study were to determine the effects of humerus intraosseous (HIO) versus intravenous (IV) administration of epinephrine in a hypovolemic, pediatric pig model. We compared concentration maximum (Cmax), time to maximum concentration (Tmax), mean concentration (MC) over time and return of spontaneous circulation (ROSC).

METHODS

Pediatric pig were randomly assigned to each group (HIO (n=7); IV (n=7); cardiopulmonary resuscitation (CPR)+defibrillation (defib) (n=7) and CPR-only group (n=5)). The pig were anesthetized; 35% of the blood volume was exsanguinated. pigs were in arrest for 2 min, and then CPR was performed for 2 min. Epinephrine 0.01 mg/kg was administered 4 min postarrest by either route. Samples were collected over 5 min. After sample collection, epinephrine was administered every 4 min or until ROSC. The Cmax and MC were analyzed using high-performance liquid chromatography. Defibrillation began at 3 min postarrest and administered every 2 min or until ROSC or endpoint at 20 min after initiation of CPR.

RESULTS

Analysis indicated that the Cmax was significantly higher in the IV versus HIO group (p=0.001). Tmax was shorter in the IV group but was not significantly different (p=0.789). The MC was significantly greater in the IV versus HIO groups at 90 and 120 s (p<0.05). The IV versus HIO had a significantly higher MC (p=0.001). χ indicated the IV group (5 out of 7) had significantly higher rate of ROSC than the HIO group (1 out of 7) (p=0.031). One subject in the CPR+defib and no subjects in the CPR-only groups achieved ROSC.

DISCUSSION

Based on the results of our study, the IV route is more effective than the HIO route.

摘要

背景

本研究的目的是在低血容量的儿科猪模型中确定肱骨骨髓腔内（HIO）注射与静脉内（IV）注射肾上腺素的效果。我们比较了最大浓度（Cmax）、达到最大浓度的时间（Tmax）、随时间的平均浓度（MC）以及自主循环恢复（ROSC）情况。

方法

将儿科猪随机分配到每组（HIO组（n = 7）；IV组（n = 7）；心肺复苏（CPR）+除颤（defib）组（n = 7）和仅进行CPR组（n = 5））。猪被麻醉；放血35%的血容量。猪心跳骤停2分钟，然后进行2分钟的CPR。在心跳骤停4分钟后通过两种途径之一给予0.01mg/kg肾上腺素。在5分钟内收集样本。样本收集后，每4分钟给予一次肾上腺素或直至ROSC。使用高效液相色谱法分析Cmax和MC。除颤在心跳骤停3分钟开始，每2分钟进行一次或直至ROSC或在CPR开始后20分钟达到终点。

结果

分析表明，IV组的Cmax显著高于HIO组（p = 0.001）。IV组的Tmax较短，但差异不显著（p = 0.789）。在90秒和120秒时，IV组的MC显著高于HIO组（p < 0.05）。IV组的MC显著高于HIO组（p = 0.001）。χ表明IV组（7只中的5只）的ROSC发生率显著高于HIO组（7只中的1只）（p = 0.031）。CPR + defib组中有1只动物实现ROSC而仅进行CPR组中无动物实现ROSC。