Balzer Claudius, Eagle Susan S, Baudenbacher Franz J, Riess Matthias L
Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
Intensive Care Med Exp. 2024 Nov 12;12(1):102. doi: 10.1186/s40635-024-00679-8.
Enhancing venous return during cardiopulmonary resuscitation (CPR) can lead to better hemodynamics and improved outcome after cardiac arrest (CA). Peripheral Intravenous Analysis (PIVA) provides feedback on venous flow changes and may indicate an increase in venous return and cardiac output during CPR. We hypothesize PIVA can serve as an early indicator of increased venous return, preceding end-tidal CO (etCO) increase, before the return of spontaneous circulation (ROSC) in a rat model of CA and CPR.
Eight male Wistar rats were intubated and ventilated, and etCO was measured. Vessels were cannulated in the tail vein, femoral vein, femoral artery, and central venous and connected to pressure transducers. Ventilation was discontinued to achieve asphyxial CA. After 8 min, CPR began with ventilation, epinephrine, and automated chest compressions 200 times per minute until mean arterial pressure increased to 120 mmHg. Waveforms were recorded and analyzed. PIVA was calculated using a Fourier transformation of venous waveforms. Data are mean ± SE. Maximum PIVA values occurred in the tail vein 34.7 ± 2.9 s before ROSC, with subsequent PIVA peaks in femoral vein and centrally at 30.9 ± 5.4 and 25.1 ± 5.0 s, respectively. All PIVA peaks preceded etCO increase (21.5 ± 3.2 s before ROSC).
PIVA consistently detected venous pressure changes prior to changes in etCO. This suggests that PIVA has the potential to serve as an important indicator of venous return and cardiac output during CPR, and also as a predictor of ROSC.
在心肺复苏（CPR）期间增强静脉回流可导致更好的血流动力学，并改善心脏骤停（CA）后的预后。外周静脉分析（PIVA）可提供静脉血流变化的反馈，并可能表明CPR期间静脉回流和心输出量增加。我们假设在CA和CPR大鼠模型中，PIVA可作为静脉回流增加的早期指标，出现在呼气末二氧化碳（etCO）增加之前，自主循环恢复（ROSC）之前。
八只雄性Wistar大鼠进行插管和通气，并测量etCO。在尾静脉、股静脉、股动脉和中心静脉插管，并连接到压力传感器。停止通气以实现窒息性CA。8分钟后，开始CPR，同时进行通气、注射肾上腺素，并以每分钟200次的频率进行自动胸外按压，直到平均动脉压升至120 mmHg。记录并分析波形。使用静脉波形的傅里叶变换计算PIVA。数据为平均值±标准误差。最大PIVA值出现在ROSC前34.7±2.9秒的尾静脉，随后股静脉和中心静脉的PIVA峰值分别出现在30.9±5.4秒和25.1±5.0秒。所有PIVA峰值均先于etCO增加（ROSC前21.5±3.2秒）。
PIVA始终能在etCO变化之前检测到静脉压力变化。这表明PIVA有潜力作为CPR期间静脉回流和心输出量的重要指标，也可作为ROSC的预测指标。
