Hoekstra O S, van Lambalgen A A, Groeneveld A B, van den Bos G C, Thijs L G
Medical Intensive Care Unit, Free University Hospital, Amsterdam, The Netherlands.
Ann Emerg Med. 1995 Mar;25(3):375-85. doi: 10.1016/s0196-0644(95)70298-9.
Abdominal compressions can be interposed between the thoracic compressions of standard CPR (SCPR). The resulting interposed abdominal compression CPR (IAC-CPR) may increase blood pressures and patient survival, particularly if applied as a primary technique after in-hospital cardiac arrest. We used a predominant cardiac compression canine model to study the effects of IAC-CPR on blood pressures and total and vital organ perfusion as a function of time after cardiac arrest and efficacy of SCPR.
In a crossover design, we measured blood pressures and total and regional blood flow (radioactive microspheres) during 6-minute episodes of mechanical SCPR and IAC-CPR, both early (4 to 16 minutes) and late (18 to 30 minutes) after induction of ventricular fibrillation in eight dogs (weight, 25 to 33 kg) under neuroleptanalgesia/anesthesia.
During IAC-CPR, the ascending aortic-right atrial pressure gradient increased (P < .05), and retrograde pressure pulses contributed to the rise of ascending aortic pressure. Within 2 minutes after the start of IAC-CPR, end-tidal CO2 fraction increased by 0.6 +/- 0.4 vol% (P < .05), suggesting enhanced venous return. IAC-CPR enhanced (P < .05) total forward blood flow (574 +/- 406 versus 394 +/- 266 mL/minute during SCPR for the early phase) and vital organ perfusion (including myocardium), in both early and late phases. The IAC-CPR-induced augmentation of blood flow was greater if perfusion was relatively high during SCPR.
Compared with predominant cardiac compressions alone (SCPR), the addition of interposed abdominal compressions (IAC-CPR) improves total and vital organ oxygen delivery through enhanced venous return and perfusion pressures.
腹部按压可插入标准心肺复苏（SCPR）的胸部按压之间。由此产生的插入式腹部按压心肺复苏（IAC-CPR）可能会提高血压和患者生存率，尤其是在院内心脏骤停后作为主要技术应用时。我们使用主要进行心脏按压的犬类模型，研究IAC-CPR对心脏骤停后不同时间点血压、全身及重要器官灌注的影响以及SCPR的效果。
采用交叉设计，我们在8只体重25至33千克的犬类在神经安定镇痛/麻醉下诱发室颤后，于早期（4至16分钟）和晚期（18至30分钟）分别进行6分钟的机械SCPR和IAC-CPR期间，测量血压、全身及局部血流（放射性微球）。
在IAC-CPR期间，升主动脉-右心房压力梯度增加（P <.05），逆行压力脉冲导致升主动脉压力升高。在IAC-CPR开始后2分钟内，呼气末二氧化碳分数增加了0.6±0.4 vol%（P <.05），提示静脉回流增强。IAC-CPR在早期和晚期均增强了（P <.05）总向前血流（早期SCPR期间为574±406 vs 394±266 mL/分钟）和重要器官灌注（包括心肌）。如果SCPR期间灌注相对较高，IAC-CPR引起的血流增加更大。
与单独主要进行心脏按压（SCPR）相比，添加插入式腹部按压（IAC-CPR）可通过增强静脉回流和灌注压力来改善全身及重要器官的氧输送。
