Wagner Julian, Mathis Simon, Spraider Patrick, Abram Julia, Baldauf Stefanie, Pinggera Daniel, Bauer Marlies, Hell Tobias, Tscholl Pia, Glodny Bernhard, Helbok Raimund, Mair Peter, Martini Judith, Putzer Gabriel
Department of Anaesthesia and Intensive Care Medicine, Medical University of Innsbruck, Austria.
Department of Neurosurgery, Medical University of Innsbruck, Austria.
Resusc Plus. 2024 Aug 5;19:100738. doi: 10.1016/j.resplu.2024.100738. eCollection 2024 Sep.
Bolus administration of adrenaline during cardiopulmonary resuscitation (CPR) results in only short-term increases in systemic and cerebral perfusion pressure (CePP) with unclear effects on cerebral oxygenation. The aim of this study was to investigate the effects of bolus compared to continuous adrenaline administration on cerebral oxygenation in a porcine CPR model.
After five minutes of cardiac arrest, mechanical CPR was performed for 15 min. Adrenaline (45 μg/kg) was administered either as a bolus every five minutes or continuously over the same period via an infusion pump. Main outcome parameter was brain tissue oxygen tension (PO), secondary outcome parameters included mean arterial pressure (MAP), intracranial pressure (ICP), CePP and cerebral regional oxygen saturation (rSO) as well as arterial and cerebral venous blood gases.
During CPR, mean MAP (45 ± 8 mmHg vs. 38 ± 8 mmHg; = 0.0827), mean ICP (27 ± 7 mmHg vs. 20 ± 7 mmHg; = 0.0653) and mean CePP (18 ± 8 mmHg vs. 18 ± 8 mmHg; = 0.9008) were similar in the bolus and the continuous adrenaline group. Also, rSO (both 24 ± 6 mmHg; = 0.9903) and cerebral venous oxygen saturation (18 ± 12% versus 27.5 ± 12%; = 0.1596) did not differ. In contrast, relative PO reached higher values in the continuous group after five minutes of CPR and remained significantly higher than in the bolus group until the end of resuscitation.
Continuous administration of adrenaline improved brain tissue oxygen tension compared with bolus administration during prolonged CPR.
在心肺复苏（CPR）期间推注肾上腺素仅会使全身和脑灌注压（CePP）出现短期升高，而对脑氧合的影响尚不清楚。本研究的目的是在猪CPR模型中研究推注与持续输注肾上腺素对脑氧合的影响。
心脏骤停5分钟后，进行15分钟的机械CPR。肾上腺素（45μg/kg）每5分钟推注一次，或在同一时期通过输液泵持续输注。主要结局参数是脑组织氧分压（PO），次要结局参数包括平均动脉压（MAP）、颅内压（ICP）、CePP和脑局部氧饱和度（rSO）以及动脉和脑静脉血气。
在CPR期间，推注组和持续输注肾上腺素组的平均MAP（45±8 mmHg对38±8 mmHg；P = 0.0827）、平均ICP（27±7 mmHg对20±7 mmHg；P = 0.0653）和平均CePP（18±8 mmHg对18±8 mmHg；P = 0.9008）相似。此外，rSO（均为24±6 mmHg；P = 0.9903）和脑静脉氧饱和度（18±12%对27.5±12%；P = 0.1596）也无差异。相比之下，在CPR 5分钟后，持续输注组的相对PO达到更高值，并且在复苏结束前一直显著高于推注组。
在长时间CPR期间，与推注肾上腺素相比，持续输注肾上腺素可改善脑组织氧分压。
