Martin G B, Carden D L, Nowak R M, Lewinter J R, Johnston W, Tomlanovich M C
Ann Emerg Med. 1986 Feb;15(2):125-30. doi: 10.1016/s0196-0644(86)80005-1.
Coronary perfusion pressure, as reflected by the diastolic aortic to right atrial (Ao-RA) pressure gradient, has been shown to correlate well with coronary blood flow during standard external CPR (SE-CPR) and is an important determinant of successful cardiac resuscitation. Few studies have documented such Ao-RA gradients in human beings, however. Twenty patients sustaining out-of-hospital cardiopulmonary arrests and basic cardiac life support were instrumented with thoracic aortic and right atrial catheters on arrival in the emergency department. The mean time from arrival in the ED to catheter placement was 16.5 +/- 6.0 minutes. With SE-CPR, peak systolic aortic and right atrial pressures were 73.7 +/- 20.2 mm Hg and 69.6 +/- 18.3 mm Hg, respectively. End diastolic aortic and right atrial pressures were 27.9 +/- 7.3 mm Hg and 20.3 +/- 7.2 mm Hg, respectively, with an end diastolic gradient of 7.9 +/- 9.1 mm Hg. Three patients had systolic Ao-RA gradients of more than 25 mm Hg, which is consistent with some cardiac compression as a mechanism of flow. Five patients also had one-minute trials of simultaneous compression and ventilation CPR (SCV-CPR). Ao-RA end diastolic gradients decreased in four of the five during SCV-CPR. No patient in this study was resuscitated successfully. We conclude that ED SE-CPR provides little coronary perfusion for victims of prehospital cardiac arrest. Although SCV-CPR has been shown to improve carotid blood flow in human beings, it appears to have an adverse effect on the already minimal myocardial perfusion provided by SE-CPR.
冠状动脉灌注压由舒张期主动脉至右心房（Ao-RA）压力梯度反映，已证实在标准体外心肺复苏（SE-CPR）期间与冠状动脉血流密切相关，并且是心脏复苏成功的重要决定因素。然而，很少有研究记录人类的这种Ao-RA梯度。20例院外心脏骤停并接受基本心脏生命支持的患者在抵达急诊科时插入了胸主动脉和右心房导管。从抵达急诊科到放置导管的平均时间为16.5±6.0分钟。进行SE-CPR时，收缩期主动脉和右心房峰值压力分别为73.7±20.2 mmHg和69.6±18.3 mmHg。舒张末期主动脉和右心房压力分别为27.9±7.3 mmHg和20.3±7.2 mmHg，舒张末期梯度为7.9±9.1 mmHg。3例患者的收缩期Ao-RA梯度超过25 mmHg，这与作为血流机制的一些心脏按压一致。5例患者还进行了同步按压和通气心肺复苏（SCV-CPR）的1分钟试验。在SCV-CPR期间，5例患者中有4例的Ao-RA舒张末期梯度下降。本研究中没有患者成功复苏。我们得出结论，急诊科的SE-CPR为院前心脏骤停患者提供的冠状动脉灌注很少。虽然SCV-CPR已证实在人类中可改善颈动脉血流，但它似乎对SE-CPR提供的本就极少的心肌灌注有不利影响。
