EFFECTS OF ARTERIAL AND VENOUS VOLUME INFUSION ON CORONARY PERFUSION PRESSURES DURING CANINE CPR

被引：30

作者：

GENTILE, NT

MARTIN, GB

APPLETON, TJ

MOEGGENBERG, J

PARADIS, NA

NOWAK, RM

机构：

[1] Hartford Hospital, Department of Emergency Medicine, CI, Hurtford

[2] Henry Ford Hospital, Department of Emergency Medicine, Detroit, MI

来源：

RESUSCITATION | 1991年 / 22卷 / 01期

关键词：

CPR; CORONARY PERFUSION PRESSURE; INTRAARTERIAL INFUSION; INTRAVENOUS INFUSION;

D O I：

10.1016/0300-9572(91)90064-6

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Intraarterial (IA) volume infusion has been reported to be more effective than intravenous (IV) infusion in treating cardiac arrest due to exsanguination. A rapid IA infusion was felt to raise intraaortic pressure and improve coronary perfusion pressure (CPP). The purpose of this study was to determine if IA or IV volume infusion could augment the effect of epinephrine on CPP during CPR in the canine model. Nineteen mongrel dogs with a mean weight of 26.3 +/- 4.2 kg were anesthetized and mechanically ventilated. Thoracic aortic (Ao), right atrial (RA) and pulmonary artery catheters were placed for hemodynamic monitoring. Additional Ao and central venous catheters were placed for volume infusion. Ventricular fibrillation was induced and Thumper(TM) CPR was begun after 5 min (t = 5). At t = 10, all dogs received 45-mu-g/kg IV epinephrine. Six animals received epinephrine alone (EPI). Five dogs received EPI plus a 500 cc bolus of normal saline over 3 min intravenously (EPI/IV). Another group (n = 8) received EPI plus the same fluid bolus through the aortic catheter (EPI/IA). Resuscitation was attempted at t = 18 using a standard protocol. There was a significant increase in CPP over baseline in all groups. The changes in CPP from baseline induced by EPI, EPI/IV and EPI/IA were 20.6 +/- 3.7, 22.8 +/- 4.2 and 22.2 +/- 2.4 mmHg, respectively. Volume loading did not augment the effect of therapeutic EPI dosing. By increasing both preload and afterload, volume administration may in fact be detrimental during CPR.

引用

页码：55 / 63

页数：9

共 20 条

[11]

Niemann, Criley, Rosborough, Et al., Predictive indices of successful cardiac resuscitation after prolonged arrest and experimental cardiopulmonary resuscitation, Ann. Emerg. Med., 14, pp. 521-528, (1985)

[12]

Sanders, Ewy, Taft, Prognostic and therapeutic importance of the aortic diastolic pressure in resuscitation from cardiac arrest, Crit. Care. Med., 12, pp. 871-873, (1984)

[13]

Diefendorf, Meador, Intra-arterial transfusion in hemorrhagic shock, Obstet. Gynecol., 16, pp. 278-282, (1960)

[14]

Tomaszewski, Meador, Theoretical effects of fluid infusion during cardiopulmonary resuscitation as demonstrated in a computer model of the circulation, Resuscitation, 15, pp. 97-112, (1987)

[15]

Berman, Akman, Intra-arterial infusion in the treatment of shock resulting from coronary occlusion, Am. Heart. J., 43, pp. 264-272, (1952)

[16]

Maloney, Smith, Gilmore, Et al., Intra-arterial and intravenous transfusion a controlled study of their effectiveness in the treatment of experimental hemorrhagic shock, Surg Gynecol Obstet, 97, pp. 529-539, (1953)

[17]

Voorhees, Ralston, Kougias, Et al., Fluid loading with whole blood or Ringer's lactate solution during CPR in dogs, Resuscitation, 15, pp. 113-123, (1987)

[18]

Niemann, Rosborough, Hausknecht, Et al., Pressure-synchronized cineangiography during experimental cardiopulmonary resuscitation, Circulation, 64, pp. 985-991, (1981)

[19]

Feneley, Maier, Gaynor, Et al., Sequence of mitral valve motion and transmitral blood flow during manual cardiopulmonary resuscitation in dogs, Circulation, 76, pp. 363-375, (1987)

[20]

Braunwald, Sonnenblich, Ross, Mechanisms of cardiac contraction and relaxation, Heart Disease: a Textbook of Cardiovascular Medicine, pp. 383-414, (1988)

← 1 2 →