Paradis N A, Rose M I, Gawryl M S
Division of Pulmonary and Critical Care Medicine, New York University Medical Center, New York 10016.
J Am Coll Cardiol. 1994 Feb;23(2):497-504. doi: 10.1016/0735-1097(94)90439-1.
The purpose of this study was to compare the perfusion pressure and rate of return of spontaneous circulation produced by standard advanced cardiac life support with that resulting from advanced cardiac life support with simultaneous aortic occlusion and proximal infusion with oxygenated fluid.
Cardiopulmonary resuscitation based solely on external chest compression is unable to achieve return of spontaneous circulation in most patients with cardiac arrest. Adjunctive therapies that enhance myocardial oxygen supply may improve outcomes.
We conducted a prospective, randomized study in mongrel dogs using a fibrillatory model of cardiac arrest with a 20-min arrest time. Dogs were randomized to two groups. Aortic arch and right atrial micromanometers were placed to measure intravascular pressure. Manual external chest compression was used and standardized to an esophageal pulse pressure of 50 mm Hg. Two minutes after initiation of advanced cardiac life support, selective aortic perfusion and oxygenation were initiated in dogs assigned to one group by inflation of an occluding balloon in the descending aorta and infusion of 450 ml of ultrapurified polymerized bovine hemoglobin through a large bore central infusion port.
Maximal aortic pressure during standard advanced cardiac life support was 42 +/- 23 (mean +/- SD) versus 69 +/- 28 mm Hg during advanced cardiac life support with selective aortic perfusion and oxygenation. Maximal coronary perfusion pressure during standard therapy was 33 +/- 21 versus 62 +/- 26 mm Hg during combined therapy. Only 2 of 10 dogs receiving standard therapy had return of spontaneous circulation versus 6 of 7 dogs receiving combined therapy. Balloon occlusion alone did not increase perfusion pressure significantly.
The use of selective aortic perfusion and oxygenation increases aortic and coronary perfusion pressures during cardiopulmonary resuscitation, resulting in a large increase in the rate of return of spontaneous circulation. This technique may be an effective adjunct to advanced cardiac life support based on any method of external chest compression and may improve the poor prognosis of patients with cardiac arrest.
本研究旨在比较标准高级心脏生命支持所产生的灌注压力和自主循环恢复率与同时进行主动脉闭塞和用含氧液体近端输注的高级心脏生命支持所产生的灌注压力和自主循环恢复率。
仅基于胸外按压的心肺复苏术在大多数心脏骤停患者中无法实现自主循环恢复。增强心肌氧供的辅助治疗可能改善预后。
我们在杂种犬中进行了一项前瞻性随机研究，采用心脏骤停颤动模型，骤停时间为20分钟。犬被随机分为两组。放置主动脉弓和右心房微测压计以测量血管内压力。使用手动胸外按压并标准化为食管脉压50毫米汞柱。在开始高级心脏生命支持两分钟后，通过在降主动脉中充盈阻塞球囊并通过大口径中心输注端口输注450毫升超纯聚合牛血红蛋白，对分配到一组的犬开始选择性主动脉灌注和氧合。
标准高级心脏生命支持期间的最大主动脉压力为42±23（平均值±标准差），而在进行选择性主动脉灌注和氧合的高级心脏生命支持期间为69±28毫米汞柱。标准治疗期间的最大冠状动脉灌注压力为33±21，而联合治疗期间为62±26毫米汞柱。接受标准治疗的10只犬中只有2只恢复了自主循环，而接受联合治疗的7只犬中有6只恢复了自主循环。单独的球囊闭塞并没有显著增加灌注压力。
在心肺复苏期间使用选择性主动脉灌注和氧合可增加主动脉和冠状动脉灌注压力，导致自主循环恢复率大幅提高。该技术可能是以任何胸外按压方法为基础的高级心脏生命支持的有效辅助手段，并可能改善心脏骤停患者的不良预后。
