Menegazzi J J, Auble T E, Nicklas K A, Hosack G M, Rack L, Goode J S
Division of Emergency Medicine, University of Pittsburgh School of Medicine, Pennsylvania.
Ann Emerg Med. 1993 Feb;22(2):240-3. doi: 10.1016/s0196-0644(05)80212-4.
To test the hypothesis that two-thumb chest compression generates higher arterial and coronary perfusion pressures than the current American Heart Association-approved two-finger method.
Randomized, crossover experimental trial.
Animal laboratory experiment with seven swine of either sex weighing 9.4 kg (SD, 0.8 kg), representing infants less than 1 year old.
Animals were sedated with IM ketamine/xylazine, intubated with a 6.0 Hi-Lo endotracheal tube, anesthetized with alpha-chloralose, and paralyzed with pancuronium. ECG was monitored continuously. Left femoral arterial and Swan-Ganz catheters were placed. Cardiac arrest was induced with an IV bolus of KCl and verified by ECG and pressure tracings. Five American Heart Association-certified basic rescuers were randomly assigned to perform external chest compressions for one minute by either the currently recommended two-finger method or the two-thumb and thorax-squeeze method. After all five completed their first trial, rescuers crossed over to the other method for a second minute of compressions. Ventilation was performed with a bag-valve device, and no drugs were given during CPR. After three complete cycles, the fourth through sixth cycles of compressions were recorded. Every compression was analyzed for arterial systolic, diastolic, mean, and coronary perfusion pressures. One thousand fifty compressions were analyzed with repeated-measures analysis of variance and Scheffé multiple comparisons.
Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and coronary perfusion pressure were all significantly higher (P < .001) with the two-thumb thoracic squeeze technique: systolic blood pressure, 59.4 versus 41.6 mm Hg; diastolic blood pressure, 21.8 versus 18.5 mm Hg; mean arterial pressure, 34.2 versus 26.1 mm Hg; and coronary perfusion pressure, 15.1 versus 12.2 mm Hg.
The two-thumb method of chest compression generates significantly higher arterial and coronary perfusion pressures than the two-finger method in this infant model of cardiac arrest.
验证与目前美国心脏协会认可的双指法相比，双拇指胸部按压能产生更高的动脉和冠状动脉灌注压这一假设。
随机交叉实验性试验。
动物实验室实验，选用7头体重9.4千克（标准差0.8千克）的雌雄不限猪，代表1岁以下婴儿。
动物通过肌肉注射氯胺酮/赛拉嗪进行镇静，用6.0号高低型气管导管插管，用α-氯醛糖麻醉，并用潘库溴铵使其麻痹。持续监测心电图。放置左股动脉和Swan-Ganz导管。静脉注射氯化钾诱导心脏骤停，并通过心电图和压力描记进行确认。5名获得美国心脏协会认证的基础急救人员被随机分配，用目前推荐的双指法或双拇指及胸廓挤压法进行1分钟的体外胸部按压。在所有5人完成第一次试验后，急救人员换用另一种方法进行第二分钟的按压。用袋阀装置进行通气，心肺复苏期间不给予药物。在三个完整周期后，记录第四至第六个按压周期。对每次按压的动脉收缩压、舒张压、平均压和冠状动脉灌注压进行分析。用重复测量方差分析和谢费多重比较法分析1050次按压。
双拇指胸廓挤压技术的收缩压、舒张压、平均动脉压和冠状动脉灌注压均显著更高（P < .001）：收缩压分别为59.4毫米汞柱和41.6毫米汞柱；舒张压分别为21.8毫米汞柱和18.5毫米汞柱；平均动脉压分别为34.2毫米汞柱和26.1毫米汞柱；冠状动脉灌注压分别为15.1毫米汞柱和12.2毫米汞柱。
在这个婴儿心脏骤停模型中，双拇指胸部按压法产生的动脉和冠状动脉灌注压明显高于双指法。
