背景:与标准机械胸部按压相比,实验性主动按压-减压(ACD)CPR与血液动力学结果增加相关。由于没有临床可用的机械胸部按压装置能够进行ACD-CPR,我们修改了LUCAS2(生理控制,隆德,瑞典)提供ACD-CPR,假设与标准LUCASCPR相比,它可以改善心脏骤停猪的血流动力学结果。
方法:在19头挪威家猪的随机交叉设计中,研究了改良的LUCAS在解剖胸部水平以上有或没有2厘米主动减压的情况下进行5厘米按压。电诱导VF并不处理2分钟。每只猪在三个180秒内接受ACD-CPR和标准机械CPR。阶段。我们测量了主动脉,右心房,冠状动脉灌注,颅内和食管压,脑和颈动脉血流量和心输出量。连续参数数据采用双侧配对样本t检验,非参数数据采用Wilcoxon检验。P<0.05被认为是显著的。
结果:由于受伤/设备故障,实验方案在19头猪中的9头中完成。心输出量(l/min,中位数,(25,75百分位数):1.5(1.1,1.7)与1.1(0.8,1.5),p<0.01),脑血流量(AU,297vs.253,平均差:44,95%CI;14-74,p=0.01),和颈动脉血流量(l/min,中位数,(25,75百分位数):97(70,106)与83(57,94),与标准机械CPR相比,ACD-CPR期间p<0.01)更高。冠状动脉灌注压(CPP)在最终减压阶段趋于更高。
结论:与标准LUCASCPR相比,机械ACD-CPR改善了心输出量和脑血流量,CPP在舒张末期趋于更高。
BACKGROUND: Experimental active compression-decompression (ACD) CPR is associated with increased haemodynamic outcomes compared to standard mechanical chest compressions. Since no clinically available mechanical chest compression device is capable of ACD-CPR, we modified the LUCAS 2 (Physio-Control, Lund, Sweden) to deliver ACD-CPR, hypothesising it would improve haemodynamic outcomes compared with standard LUCAS CPR on pigs with cardiac arrest.
METHODS: The modified LUCAS delivering 5 cm compressions with or without 2 cm active decompression above anatomical chest level was studied in a randomized crossover design on 19 Norwegian domestic pigs. VF was electrically induced and untreated for 2 min. Each pig received ACD-CPR and standard mechanical CPR in three 180-s. phases. We measured aortic, right atrial, coronary perfusion, intracranial and oesophageal pressure, cerebral and carotid blood flow and cardiac output. Two-sided paired samples t-test was used for continuous parametric data and Wilcoxon test for non-parametric data. P < 0.05 was considered significant.
RESULTS: Due to injuries/device failure, the experimental protocol was completed in nine of 19 pigs. Cardiac output (l/min, median, (25, 75-percentiles): 1.5 (1.1, 1.7) vs. 1.1 (0.8, 1.5), p < 0.01), cerebral blood flow (AU, 297 vs. 253, mean difference: 44, 95% CI; 14-74, p = 0.01), and carotid blood flow (l/min, median, (25, 75-percentiles): 97 (70, 106) vs. 83 (57, 94), p < 0.01) were higher during ACD-CPR compared to standard mechanical CPR. Coronary perfusion pressure (CPP) trended towards higher in end decompression phase.
CONCLUSIONS: Cardiac output and brain blood flow improved with mechanical ACD-CPR and CPP trended towards higher during end-diastole compared to standard LUCAS CPR.