Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Crit Care Med. 2024 Feb 1;52(2):e67-e78. doi: 10.1097/CCM.0000000000006089. Epub 2023 Nov 3.
Current international guidelines recommend administrating calcium chloride and sodium bicarbonate to patients with hyperkalemia-induced cardiac arrest, despite limited evidence. The aim of this study was to evaluate the efficacy of calcium chloride and sodium bicarbonate on return of spontaneous circulation (ROSC) in a pig model of hyperkalemia-induced cardiac arrest.
A randomized, blinded, placebo-controlled experimental pig study. Hyperkalemia was induced by continuous infusion of potassium chloride over 45 minutes followed by a bolus. After a no flow period of 7 minutes, pigs first received 2 minutes of basic cardiopulmonary resuscitation and subsequently advanced life support. The first intervention dose was administered after the fifth rhythm analysis, followed by a defibrillation attempt at the sixth rhythm analysis. A second dose of the intervention was administered after the seventh rhythm analysis if ROSC was not achieved. In case of successful resuscitation, pigs received intensive care for 1 hour before termination of the study.
University hospital laboratory.
Fifty-four female Landrace/Yorkshire/Duroc pigs (38-42 kg).
The study used a 2 × 2 factorial design, with calcium chloride (0.1 mmol/kg) and sodium bicarbonate (1 mmol/kg) as the interventions.
Fifty-two pigs were included in the study. Sodium bicarbonate significantly increased the number of animals achieving ROSC (24/26 [92%] vs. 13/26 [50%]; odds ratio [OR], 12.0; 95% CI, 2.3-61.5; p = 0.003) and reduced time to ROSC (hazard ratio [HR] 3.6; 95% CI, 1.8-7.5; p < 0.001). There was no effect of calcium chloride on the number of animals achieving ROSC (19/26 [73%] vs. 18/26 [69%]; OR, 1.2; 95% CI, 0.4-4.0; p = 0.76) or time to ROSC (HR, 1.5; 95% CI, 0.8-2.9; p = 0.23).
Administration of sodium bicarbonate significantly increased the number of animals achieving ROSC and decreased time to ROSC. There was no effect of calcium chloride on the number of animals achieving ROSC or time to ROSC.
目前国际指南建议对高钾血症引起心搏骤停的患者使用氯化钙和碳酸氢钠，但证据有限。本研究旨在评估氯化钙和碳酸氢钠对高钾血症诱导的心搏骤停猪模型中自主循环恢复（ROSC）的疗效。
一项随机、盲法、安慰剂对照的实验性猪研究。通过 45 分钟的氯化钾持续输注诱导高钾血症，随后推注。无血流 7 分钟后，猪首先接受 2 分钟的基础心肺复苏，随后接受高级生命支持。第一次干预剂量在第五次节律分析后给予，第六次节律分析时进行除颤尝试。如果未实现 ROSC，则在第七次节律分析后给予干预的第二次剂量。如果复苏成功，猪在研究结束前接受 1 小时的重症监护。
大学医院实验室。
54 头雌性长白/约克郡/杜洛克猪（38-42kg）。
该研究采用 2×2 析因设计，干预措施为氯化钙（0.1mmol/kg）和碳酸氢钠（1mmol/kg）。
52 头猪纳入研究。碳酸氢钠显著增加了实现 ROSC 的动物数量（24/26[92%]比 13/26[50%]；比值比[OR]，12.0；95%CI，2.3-61.5；p=0.003），并缩短了 ROSC 时间（风险比[HR]，3.6；95%CI，1.8-7.5；p<0.001）。氯化钙对实现 ROSC 的动物数量（19/26[73%]比 18/26[69%]；OR，1.2；95%CI，0.4-4.0；p=0.76）或 ROSC 时间（HR，1.5；95%CI，0.8-2.9；p=0.23）均无影响。
给予碳酸氢钠可显著增加实现 ROSC 的动物数量，并缩短 ROSC 时间。氯化钙对实现 ROSC 的动物数量或 ROSC 时间无影响。
