Rivers E P, Lozon J, Enriquez E, Havstad S V, Martin G B, Lewandowski C A, Goetting M G, Rosenberg J A, Paradis N A, Nowak R M
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI 48202.
Crit Care Med. 1993 Jun;21(6):878-83. doi: 10.1097/00003246-199306000-00016.
To examine the validity of interchanging arterial sites and their responses to graded doses of epinephrine during human cardiopulmonary resuscitation (CPR).
Consecutive case series.
Large, urban Emergency Department.
Adult, normothermic, nonhemorrhagic cardiac arrest patients.
While receiving advanced cardiac life support, patients received right atrial (n = 40), aortic (n = 40), radial (n = 40), and femoral (n = 17) artery catheters. Pressures were measured simultaneously at baseline, after 0.01 mg/kg and 0.2 mg/kg of epinephrine.
The mean aortic compression-phase pressure was 9.3 +/- 10 (SD), 8.1 +/- 11, and 4.4 +/- 9.5 mm Hg higher than radial artery pressure at baseline, after 0.01 mg/kg, and 0.2 mg/kg of epinephrine, respectively (all statistically significant). When compared with the femoral artery at the same time points, the mean aortic compression-phase pressure was also 3.0 +/- 6.8, 1.9 +/- 8, and 0.6 +/- 7.7 mm Hg higher, respectively (none statistically significant). The aortic relaxation-phase pressure was 1.3 +/- 3.6, 1.1 +/- 3.8, and 1.6 +/- 2.5 mm Hg lower than the radial artery at baseline, after 0.01 mg/kg and 0.2 mg/kg of epinephrine, respectively (all statistically significant). When compared with the femoral artery at the same time points, the aortic relaxation-phase pressure was 0.6 +/- 2.0, 0.3 +/- 3.3, and 0.3 +/- 2.4 mm Hg lower, respectively (none statistically significant).
Radial artery relaxation-phase pressure, although statistically higher, correlated with aortic relaxation-phase pressure. Femoral artery relaxation-phase pressure was not statistically different from aortic relaxation-phase pressure. Aortic pressure was statistically higher and had a lower correlation with radial artery pressures during compression phase. The aortic to radial artery and aortic to femoral artery compression-phase gradients abated with increasing doses of epinephrine therapy. Caution must be used when substituting compression-phase pressure obtained at radial or femoral artery sites for aortic pressure during human CPR. Coronary artery perfusion pressures obtained with radial and femoral arteries correlate with aortic pressure when measuring the response to vasopressor therapy during CPR when an interpretable waveform exists.
探讨在人类心肺复苏（CPR）期间互换动脉穿刺部位的有效性及其对不同剂量肾上腺素的反应。
连续病例系列。
大型城市急诊科。
成年、体温正常、非出血性心脏骤停患者。
在接受高级心脏生命支持时，患者接受右心房（n = 40）、主动脉（n = 40）、桡动脉（n = 40）和股动脉（n = 17）置管。在基线、给予0.01 mg/kg和0.2 mg/kg肾上腺素后同时测量压力。
在基线、给予0.01 mg/kg和0.2 mg/kg肾上腺素后，主动脉按压期平均压力分别比桡动脉压力高9.3±10（标准差）、8.1±11和4.4±9.5 mmHg（均具有统计学意义）。在相同时间点与股动脉相比，主动脉按压期平均压力分别也高3.0±6.8、1.9±8和0.6±7.7 mmHg（均无统计学意义）。在基线、给予0.01 mg/kg和0.2 mg/kg肾上腺素后，主动脉舒张期压力分别比桡动脉压力低1.3±3.6、1.1±3.8和1.6±2.5 mmHg（均具有统计学意义）。在相同时间点与股动脉相比，主动脉舒张期压力分别低0.6±2.0、0.3±3.3和0.3±2.4 mmHg（均无统计学意义）。
桡动脉舒张期压力虽然在统计学上较高，但与主动脉舒张期压力相关。股动脉舒张期压力与主动脉舒张期压力在统计学上无差异。在按压期，主动脉压力在统计学上较高，且与桡动脉压力的相关性较低。随着肾上腺素治疗剂量增加，主动脉与桡动脉以及主动脉与股动脉的按压期梯度减小。在人类CPR期间，用桡动脉或股动脉部位获得的按压期压力替代主动脉压力时必须谨慎。当在CPR期间测量对血管升压药治疗的反应且存在可解释的波形时，用桡动脉和股动脉获得的冠状动脉灌注压力与主动脉压力相关。
