Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Anesthesiology and Intensive Care Medicine, Elbe Hospital Stade, Stade, Germany.
Sci Rep. 2021 Mar 5;11(1):5326. doi: 10.1038/s41598-021-83925-3.
Although beneficial effects of an early goal directed therapy (EGDT) after cardiac arrest and successful return of spontaneous circulation (ROSC) have been described, clinical implementation in this period seems rather difficult. The aim of the present study was to investigate the feasibility and the impact of EGDT on myocardial damage and function after cardiac resuscitation. A translational pig model which has been carefully adapted to the clinical setting was employed. After 8 min of cardiac arrest and successful ROSC, pigs were randomized to receive either EGDT (EGDT group) or therapy by random computer-controlled hemodynamic thresholds (noEGDT group). Therapeutic algorithms included blood gas analysis, conductance catheter method, thermodilution cardiac output and transesophageal echocardiography. Twenty-one animals achieved successful ROSC of which 13 pigs survived the whole experimental period and could be included into final analysis. cTnT and LDH concentrations were lower in the EGDT group without reaching statistical significance. Comparison of lactate concentrations between 1 and 8 h after ROSC exhibited a decrease to nearly baseline levels within the EGDT group (1 h vs 8 h: 7.9 vs. 1.7 mmol/l, P < 0.01), while in the noEGDT group lactate concentrations did not significantly decrease. The EGDT group revealed a higher initial need for fluids (P < 0.05) and less epinephrine administration (P < 0.05) post ROSC. Conductance method determined significant higher values for preload recruitable stroke work, ejection fraction and maximum rate of pressure change in the ventricle for the EGDT group. EGDT after cardiac arrest is associated with a significant decrease of lactate levels to nearly baseline and is able to improve systolic myocardial function. Although the results of our study suggest that implementation of an EGDT algorithm for post cardiac arrest care seems feasible, the impact and implementation of EGDT algorithms after cardiac arrest need to be further investigated.
虽然已经描述了心脏骤停后早期目标导向治疗（EGDT）的有益效果，并且自主循环恢复（ROSC）成功，但在此期间临床实施似乎相当困难。本研究的目的是研究 EGDT 对心脏复苏后心肌损伤和功能的影响。本研究采用了一种经过精心适应临床环境的转化猪模型。心脏骤停 8 分钟并成功 ROSC 后，猪被随机分为接受 EGDT（EGDT 组）或随机计算机控制的血流动力学阈值治疗（无 EGDT 组）。治疗算法包括血气分析、电导导管法、热稀释心输出量和经食管超声心动图。21 只动物成功 ROSC，其中 13 只猪存活整个实验期，并可纳入最终分析。cTnT 和 LDH 浓度在 EGDT 组较低，但未达到统计学意义。ROSC 后 1 小时和 8 小时乳酸浓度比较显示，EGDT 组乳酸浓度接近基线水平（1 小时比 8 小时：7.9 比 1.7mmol/L，P<0.01），而无 EGDT 组乳酸浓度无明显下降。EGDT 组 ROSC 后初始液体需求较高（P<0.05），肾上腺素用量较少（P<0.05）。电导法测定 EGDT 组前负荷可诱导的收缩功、射血分数和心室最大压力变化率显著较高。心脏骤停后 EGDT 与乳酸水平显著降低至接近基线水平相关，并能改善收缩期心肌功能。虽然我们的研究结果表明，实施心脏骤停后 EGDT 算法似乎是可行的，但需要进一步研究 EGDT 算法对心脏骤停的影响和实施。
