Patel Neerav, Edwards Joseph, Abdou Hossam, Stonko David P, Treffalls Rebecca N, Elansary Noha N, Ptak Thomas, Morrison Jonathan J
R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, United States.
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, United States.
Front Physiol. 2022 Oct 4;13:988833. doi: 10.3389/fphys.2022.988833. eCollection 2022.
Patients in cardiac arrest treated with resuscitative thoracotomy and open cardiac massage (OCM) have high rates of mortality with poor neurological outcomes. The aim of this study is to quantitate cerebral perfusion during OCM using computed tomography perfusion (CTP) imaging in a swine model of normo- and hypovolemia. Anesthetized swine underwent instrumentation with right atrial and aortic pressure catheters. A catheter placed in the ascending aorta was used to administer iodinated contrast and CTP imaging acquired. Cerebral blood flow (CBF; ml/100 g of brain) and time to peak (TTP; s) were measured. Animals were then euthanized by exsanguination (hypovolemic group) or potassium chloride injection (normovolemic group) and subjected to a clamshell thoracotomy, aortic cross clamping, OCM, and repeated CTP. Data pertaining to peak coronary perfusion pressure (pCoPP; mmHg) were collected and % CoPP > 15 mmHg (% CoPP; s) calculated post hoc. Normovolemic animals ( = 5) achieved superior pCoPP compared to the hypovolemic animals ( = 5) pCoPP (39.3 vs. 12.3, < 0.001) and % CoPP (14.5 ± 1.9 vs. 30.9 ± 6.5, < 0.001). CTP acquisition was successful and TTP elongated from spontaneous circulation, normovolemia to hypovolemia (5.7 vs. 10.8 vs. 14.8, = 0.01). CBF during OCM was similar between hypovolemic and normovolemic groups (7.5 ± 8.1 vs. 4.9 ± 6.0, = 0.73) which was significantly lower than baseline values (51.9 ± 12.1, < 0.001). OCM in normovolemia generates superior coronary hemodynamics compared to hypovolemia. Despite this, neither generates adequate CBF as measured by CTP, compared to baseline. To improve the rate of neurologically intact survivors, novel resuscitative techniques need to be investigated that specifically target cerebral perfusion as existing techniques are inadequate.
接受复苏性开胸手术和开胸心脏按压（OCM）治疗的心脏骤停患者死亡率高，神经功能预后差。本研究的目的是在正常血容量和低血容量猪模型中，使用计算机断层扫描灌注（CTP）成像定量OCM期间的脑灌注。麻醉的猪接受右心房和主动脉压力导管置入。将一根导管置于升主动脉用于注入碘化造影剂并进行CTP成像。测量脑血流量（CBF；ml/100g脑）和达峰时间（TTP；s）。然后通过放血（低血容量组）或注射氯化钾（正常血容量组）对动物实施安乐死，并进行蛤壳式开胸手术、主动脉交叉钳夹、OCM和重复CTP检查。收集与峰值冠状动脉灌注压（pCoPP；mmHg）相关的数据，并在事后计算pCoPP＞15mmHg的百分比（%CoPP；s）。与低血容量动物（n = 5）相比，正常血容量动物（n = 5）的pCoPP更高（39.3对12.3，P＜0.001），%CoPP也更高（14.5±1.9对30.9±6.5，P＜0.001）。CTP采集成功，TTP从自主循环、正常血容量到低血容量逐渐延长（5.7对10.8对14.8，P = 0.01）。低血容量组和正常血容量组OCM期间的CBF相似（7.5±8.1对4.9±6.0，P = 0.73），均显著低于基线值（51.9±12.1，P＜0.001）。与低血容量相比，正常血容量下的OCM产生更好的冠状动脉血流动力学。尽管如此，与基线相比，通过CTP测量，两者均未产生足够的CBF。为了提高神经功能完好幸存者的比例，需要研究新的复苏技术，因为现有技术不足，这些新技术应专门针对脑灌注。
