Vincent J L, Thijs L, Weil M H, Michaels S, Silverberg R A
Circulation. 1981 Jul;64(1):18-27. doi: 10.1161/01.cir.64.1.18.
Electromechanical dissociation (EMD) is the most frequent cause of unsuccessful cardiac resuscitation in critically ill patients. In a clinical study of cardiac arrest, including 54 episodes in 50 fully monitored patients, 14 episodes of ventricular fibrillation were observed and seven were reversed. In the remaining 40 instances, 36 cases of EMD were initially observed. Four patients had asystole. None of the patients with EMD or asystole were successfully resuscitated. For objective study of EMD and its treatment, we developed an experimental model in which ventricular fibrillation was induced in mechanically ventilated dogs. EMD was predictably observed when, after an interval of 120 seconds, ventricular fibrillation was reversed with an external countershock. Neither metabolic acidosis nor metabolic alkalosis modified the incidence of EMD. A few dogs were pretreated with glucose-insulin-potassium or pharmacologic doses of methylprednisolone, but this did not clearly reduce the incidence of EMD. However, the onset of EMD was delayed when the body temperature of the animal was spontaneously reduced.
电机械分离（EMD）是重症患者心脏复苏失败的最常见原因。在一项心脏骤停的临床研究中，对50例全程监测的患者进行了54次发作观察，观察到14次室颤发作，其中7次得以逆转。在其余40例中，最初观察到36例电机械分离。4例患者出现心搏停止。所有电机械分离或心搏停止的患者均未成功复苏。为了对电机械分离及其治疗进行客观研究，我们建立了一个实验模型，在机械通气的犬身上诱发室颤。在间隔120秒后用体外除颤逆转室颤时，可以预见会出现电机械分离。代谢性酸中毒和代谢性碱中毒均未改变电机械分离的发生率。几只犬预先接受了葡萄糖-胰岛素-钾治疗或药理剂量的甲基泼尼松龙治疗，但这并未明显降低电机械分离的发生率。然而，当动物体温自发降低时，电机械分离的发作会延迟。
