Lindner K H, Pfenninger E G, Lurie K G, Schürmann W, Lindner I M, Ahnefeld F W
Department of Anesthesiology and Critical Care Medicine, University of Ulm, Germany.
Circulation. 1993 Sep;88(3):1254-63. doi: 10.1161/01.cir.88.3.1254.
This study was designed to assess the effects of a modified cardiopulmonary resuscitation (CPR) technique that consists of both active compression and active decompression of the chest (ACD CPR) versus standard CPR (STD CPR) on myocardial and cerebral blood flow during ventricular fibrillation both before and after epinephrine administration.
During a 30-second period of ventricular fibrillation cardiac arrest, 14 pigs were randomized to receive either STD CPR (n = 7) or ACD CPR (n = 7). Both STD and ACD CPR were performed using an automated pneumatic piston device applied midsternum, designed to provide either active chest compression (1.5 to 2.0 in.) and decompression or only active compression of the chest at 80 compressions per minute and 50% duty cycle. Using radiolabeled microspheres, median total myocardial blood flow after 5 minutes of ventricular fibrillation was 14 (7 to 30, minimum to maximum) STD CPR versus 30 (9 to 46) mL.min-1 x 100 g-1 with ACD CPR (P < .05). Median cerebral blood flow was 15 (10 to 26) mL.min-1 x 100 g-1 with STD CPR and 30 (21 to 39) with ACD CPR (P < .01). When comparing STD with ACD CPR, aortic systolic (62 mm Hg [48 to 70] vs 80 [59 to 86]) and diastolic (22 [18 to 28] vs 28 [21 to 36]) pressures, calculated coronary systolic (30 [22 to 36] vs 49 [37 to 56]) and diastolic (18 [16 to 23] vs 26 [21 to 31]) perfusion pressures, end-tidal CO2 (1.4% [0.8 to 1.8] vs 2.1 (1.8 to 2.4]), cerebral O2 delivery (3.1 mL.min-1 x 100 g-1 [1.5 to 4.5] vs 5.3 [3.8 to 7.5]), and cerebral perfusion pressure (14 mm Hg [4 to 22] vs 26 [6 to 34]) were all significantly higher with ACD CPR: To compare these parameters before and after vasopressor therapy, a bolus of high-dose epinephrine (0.2 mg/kg) was given to all animals after 5 minutes of ventricular fibrillation. Organ blood flow and calculated perfusion pressures increased significantly in both the STD and ACD groups after epinephrine. The differences observed between STD and ACD CPR before epinephrine were diminished 90 seconds after epinephrine but were again statistically significant when assessed 5 minutes later, once the acute effects of epinephrine had decreased. No difference in short-term resuscitation success was found between the two groups.
We conclude that ACD CPR significantly increases myocardial and cerebral blood flow during cardiac arrest in the absence of vasopressor therapy compared with STD CPR:
本研究旨在评估一种改良的心肺复苏（CPR）技术的效果，该技术包括胸部的主动按压和主动减压（ACD CPR），与标准CPR（STD CPR）相比，在肾上腺素给药前后心室颤动期间对心肌和脑血流的影响。
在30秒的心室颤动心脏骤停期间，14头猪被随机分为接受STD CPR（n = 7）或ACD CPR（n = 7）。STD CPR和ACD CPR均使用应用于胸骨中部的自动气动活塞装置进行，该装置旨在提供主动胸部按压（1.5至2.0英寸）和减压，或仅以每分钟80次按压和50%的占空比进行胸部主动按压。使用放射性微球，心室颤动5分钟后的心肌总血流中位数在STD CPR组为14（7至30，最小值至最大值）mL·min⁻¹×100 g⁻¹，而ACD CPR组为30（9至46）mL·min⁻¹×100 g⁻¹（P < 0.05）。STD CPR组的脑血流中位数为15（10至26）mL·min⁻¹×100 g⁻¹，ACD CPR组为30（21至39）mL·min⁻¹×100 g⁻¹（P < 0.01）。比较STD CPR和ACD CPR时，主动脉收缩压（62 mmHg [48至70] 对80 [59至86]）和舒张压（22 [18至28] 对28 [21至36]）、计算得出的冠状动脉收缩压（30 [22至36] 对49 [37至56]）和舒张压（18 [16至23] 对26 [21至31]）灌注压、呼气末二氧化碳分压（1.4% [0.8至1.8] 对2.1 [（1.8至2.4]）、脑氧输送量（3.1 mL·min⁻¹×100 g⁻¹ [1.5至4.5] 对5.3 [3.8至7.5]）以及脑灌注压（14 mmHg [4至22] 对26 [6至34]）在ACD CPR时均显著更高：为比较血管升压药治疗前后的这些参数，在心室颤动5分钟后给所有动物静脉注射大剂量肾上腺素（0.2 mg/kg）。肾上腺素给药后，STD组和ACD组的器官血流和计算得出的灌注压均显著增加。肾上腺素注射后90秒，STD CPR和ACD CPR之间在肾上腺素注射前观察到的差异减小，但在5分钟后评估时再次具有统计学意义，此时肾上腺素的急性作用已经减弱。两组之间在短期复苏成功率方面未发现差异。
我们得出结论，与STD CPR相比，在没有血管升压药治疗的心脏骤停期间，ACD CPR显著增加心肌和脑血流。
