在模拟院外心脏骤停中对上升型与矩形经胸除颤波形进行首次评估。

First-time evaluation of ascending compared to rectangular transthoracic defibrillation waveforms in modelled out-of-hospital cardiac arrest.

作者信息

Neumann Tobias, Finke Simon-Richard, Henninger Maja, Lemke Sebastian, Hoepfner Ben, Steven Daniel, Maul Alexandra C, Schroeder Daniel C, Annecke Thorsten

机构信息

University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Research Group "Clinical Research and Teaching", Kerpener Str. 62, 50937 Cologne, Germany.

University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Electrophysiology, Kerpener Str. 62, 50937 Cologne, Germany.

出版信息

Resusc Plus. 2020 Jun 1;1-2:100006. doi: 10.1016/j.resplu.2020.100006. eCollection 2020 Mar-Jun.

DOI:10.1016/j.resplu.2020.100006

PMID:34223293

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8244241/

Abstract

AIM OF THE STUDY

Prognosis in out-of-hospital cardiac arrest (OHCA) depends on cardiopulmonary resuscitation (CPR) duration. Therefore, the optimal biphasic defibrillation waveform shows high conversion rates besides low energy. Matthew Fishler theoretically predicted it to be truncated ascending exponential. We realised a prototypic defibrillator and compared ascending with conventional rectangular waveforms in modelled OHCA and CPR.

METHODS

Approved by the authorities, 57 healthy swine (Landrace × Piétrain) were randomised to ASCDefib ( 26) or CONVDefib ( 26). Five swine served as sham control. We induced ventricular fibrillation (VF) electrically in anaesthetised swine randomised to ASCDefib or CONVDefib and discontinued mechanical ventilation. After 5 min of untreated cardiac arrest, we started CPR with mechanical chest compressions and ventilation. We performed transthoracic biphasic defibrillations after 2, 4, 6 and 8 min CPR targeting 4 J/kg in either group. Depending on the randomised group, the defibrillation protocol was either three ascending followed by one rectangular waveform (ASCDefib) or three rectangular followed by one ascending waveform (CONVDefib).

RESULTS

Under our model-specific conditions, VF was initially terminated by 13/80 ascending waveforms and 13/79 rectangular waveforms and persistent return of spontaneous circulation was achieved in 8/26 (ASCDefib) vs. 10/26 (CONVDefib) animals. Mean current rather than waveform design was predictive for defibrillation success in a generalised linear model.

CONCLUSION

Contrary to theoretical assumptions, transthoracic biphasic defibrillation with ascending waveforms is not superior to rectangular waveforms in modelled OHCA. We advocate defibrillation dosage to be guided by current, that has proven its predictive value again.

INSTITUTIONAL PROTOCOL NUMBER

84-02.04.2017.A176.

摘要

研究目的

院外心脏骤停（OHCA）的预后取决于心肺复苏（CPR）持续时间。因此，除了能量较低外，最佳双相除颤波形还应具有高转化率。马修·菲什勒从理论上预测其为截断上升指数波形。我们制作了一台原型除颤器，并在模拟的OHCA和CPR中比较了上升波形与传统矩形波形。

方法

经当局批准，将57头健康猪（长白猪×皮特兰猪）随机分为ASCDefib组（26头）或CONVDefib组（26头）。5头猪作为假手术对照。我们对随机分为ASCDefib组或CONVDefib组的麻醉猪进行电诱导室颤（VF），并停止机械通气。在未经治疗的心脏骤停5分钟后，我们开始进行机械胸外按压和通气的CPR。在CPR 2、4、6和8分钟后，两组均进行经胸双相除颤，目标能量为4 J/kg。根据随机分组情况，除颤方案要么是三个上升波形后接一个矩形波形（ASCDefib），要么是三个矩形波形后接一个上升波形（CONVDefib）。