Power Adam, Parekh Asha, Landau John, Rezende-Neto Joao
Department of Surgery, Western University, London, Ontario, Canada.
School of Biomedical Engineering, Western University, London, Ontario, Canada.
Resusc Plus. 2024 Jul 15;19:100710. doi: 10.1016/j.resplu.2024.100710. eCollection 2024 Sep.
The objectives of this study were to assess the return of spontaneous circulation rates and hemodynamic response of large swine (>65Kg) during cardiopulmonary resuscitation after nontraumatic cardiac arrest using the COBRA-OS® aortic occlusion balloon and to address limitations of large swine closed-chest cardiopulmonary resuscitation by comparing closed-chest vs. open-chest cardiopulmonary resuscitation.
Yorkshire pigs ( = 10) weighing >65 kg were anesthetized and ventilated. After 7 min of untreated ventricular fibrillation (VF), animals were randomized to receive mechanical closed-chest cardiopulmonary resuscitation or open-chest cardiac massage. Following a 5-minute low-flow state, advanced cardiac life support algorithms were started and the COBRA-OS® was inflated in the thoracic aorta. Animals that achieved return of spontaneous circulation were re-started on mechanical ventilation and medications, CPR, defibrillation, and aortic occlusion were discontinued. The primary outcome was return of spontaneous circulation and secondary outcomes were mean arterial pressures generated in the low flow and aortic occlusion states before return of spontaneous circulation. Groups were compared with a -test or Mann-Whitney test for normal and non-parametric data, respectively, while categorical data was compared with the chi square test.
Return of spontaneous circulation was obtained in 4 animals (80%) in the open cardiac massage group and none in the mechanical closed-chest CPR group ( < 0.05). The COBRA-OS® successfully occluded all aortas and animals experienced higher mean arterial pressures in both groups with aortic occlusion (median 15 mm Hg, IQR 13-23 mm Hg), but with a higher MAP difference in the open cardiac massage group (-12.2 mm Hg, [-2.581, -21.819]).
Consideration should be given to intra-thoracic cardiac massage to increase cardiopulmonary resuscitation effectiveness and therefore return of spontaneous circulation rates in large (>65 kg) swine models of nontraumatic cardiac arrest. The COBRA-OS® demonstrated feasibility for use in this model.The Keenan Research Center, Li Ka Shing Knowledge Institute of St. Michael's Hospital Animal Care Committee: ACC Protocol #726.
本研究的目的是评估使用COBRA-OS®主动脉阻断球囊对体重超过65千克的大型猪在非创伤性心脏骤停后心肺复苏期间自主循环恢复率和血流动力学反应，并通过比较闭胸与开胸心肺复苏来解决大型猪闭胸心肺复苏的局限性。
将10头体重超过65千克的约克夏猪麻醉并进行通气。在未经治疗的室颤（VF）7分钟后，将动物随机分为接受机械闭胸心肺复苏或开胸心脏按压。在5分钟的低流量状态后，启动高级心脏生命支持算法，并在胸主动脉中充盈COBRA-OS®。实现自主循环恢复的动物重新开始机械通气和用药，停止心肺复苏、除颤和主动脉阻断。主要结局是自主循环恢复，次要结局是自主循环恢复前低流量和主动脉阻断状态下产生的平均动脉压。分别使用t检验或Mann-Whitney检验对正常和非参数数据进行组间比较，而分类数据则使用卡方检验进行比较。
开胸心脏按压组有4只动物（80%）实现了自主循环恢复，而机械闭胸心肺复苏组无一例实现自主循环恢复（P<0.05）。COBRA-OS®成功阻断了所有主动脉，两组动物在主动脉阻断时平均动脉压均升高（中位数15毫米汞柱，四分位间距13 - 23毫米汞柱），但开胸心脏按压组的平均动脉压差值更高（-12.2毫米汞柱，[-2.581，-21.819]）。
在体重超过65千克的大型非创伤性心脏骤停猪模型中，应考虑进行开胸心脏按压以提高心肺复苏效果，从而提高自主循环恢复率。COBRA-OS®在该模型中显示出应用的可行性。圣迈克尔医院动物护理委员会基南研究中心：ACC方案#726 。
