MILD HYPOTHERMIA AFTER CARDIAC-ARREST IN DOGS DOES NOT AFFECT POSTARREST CEREBRAL OXYGEN-UPTAKE DELIVERY MISMATCHING

被引：26

作者：

KUBOYAMA, K ^{[1
]}

SAFAR, P ^{[1
]}

OKU, K ^{[1
]}

OBRIST, W ^{[1
]}

LEONOV, Y ^{[1
]}

STERZ, F ^{[1
]}

TISHERMAN, SA ^{[1
]}

STEZOSKI, SW ^{[1
]}

机构：

[1] UNIV PITTSBURGH,MED CTR,INT RESUSCITAT RES CTR,DEPT ANESTHESIOL & CRIT CARE MED,PITTSBURGH,PA 15260

来源：

RESUSCITATION | 1994年 / 27卷 / 03期

关键词：

CARDIOPULMONARY RESUSCITATION; CEREBRAL RESUSCITATION; CEREBRAL METABOLISM; CEREBRAL OXYGEN UTILIZATION; GLOBAL CEREBRAL ISCHEMIA;

D O I：

10.1016/0300-9572(94)90037-X

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose: To compare measurements of cerebral arteriovenous oxygen content differences (oxygen extraction ratios, oxygen utilization coefficients) in dogs after cardiac arrest, resuscitated under normothermia vs. mild hypothermia for 1-2 h or 12 h. Methods: In 20 dogs, we used our model of ventricular fibrillation (no blood flow) of 12.5 min, reperfusion with brief cardiopulmonary bypass, and controlled ventilation, normotension, normoxemia, and mild hypocapnia to 24 h. We compared a normothermic control Group I (37.5-degrees-C) (n = 8); with brief mild hypothermia in Group II (core and tympanic membrane temperature about 34-degrees-C during the first hour after arrest) (n = 6); and with prolonged mild hypothermia in Group III (34-degrees-C during the first 12 h after arrest) (n = 6). Results: In Group I, the cerebral arteriovenous O2 content difference was 5.6 +/- 1.6 ml/dl before arrest; was low during reperfusion (transient hyperemia) and increased (worsened) significantly to 8.8 +/- 2.8 ml/dl at 1 h, remained increased until 18 h, and returned to baseline levels at 24 h after reperfusion. These values were not significantly different in hypothermic Groups II and III. The cerebral venous (saggital sinus) PO2 (P(ss)O2) was about 40 mmHg (range 29-53) in all three groups before arrest and decreased significantly below baseline values, between 1 h and 18 h after arrest; the lowest mean values were 19 +/- 19 mmHg in Group I, 15 +/- 8 in Group II (NS), and 21 +/- 3 in Group III (NS). Postarrest P(ss)O2 values of less-than-or-equal-to 20 mmHg were found in 6/8 dogs in Group I, 5/6 in Group II and 4/6 in Group III. Among the 120 values of P(ss)O2 measured between 1 h and 18 h after arrest, 32 were below the critical value of 20 mmHg. Conclusions: After prolonged cardiac arrest, critically low cerebral venous O2 values suggest inadequate cerebral O2 delivery. Brief or prolonged mild hypothermia after arrest does not mitigate the postarrest cerebral O2 uptake/delivery mismatching.

引用

页码：231 / 244

页数：14

共 39 条

[21]

Sterz, Leonov, Safar, Johnson, Oku, Tisherman, Latchaw, Obrist, Stezoski, Hecht, Tarr, Janosky, Multifocal cerebral blood flow by Xe-CT and global cerebral metabolism after prolonged cardiac arrest in dogs. Reperfusion with open-chest CPR or cardiopulmonary bypass, Resuscitation, 24, pp. 27-47, (1992)

[22]

Leonov, Sterz, Safar, Johnson, Tisherman, Oku, Hypertension with hemodilution prevents multifocal cerebral hypoperfusion after cardiac arrest in dogs, Stroke, 23, pp. 45-53, (1992)

[23]

Sterz, Safar, Johnson, Oku, Tisherman, Effects of U74006F on multifocal cerebral blood flow and metabolism after cardiac arrest in dogs, Stroke, 22, pp. 889-895, (1991)

[24]

Oku, Sterz, Safar, Johnson, Obrist, Leonov, Kuboyama, Tisherman, Mild hypothermia after cardiac arrest in dogs does not affect post-arrest multifocal cerebral hypoperfusion, Stroke, 24, pp. 1590-1598, (1993)

[25]

Oku, Kuboyama, Safar, Obrist, Sterz, Leonov, Tisherman, Cerebral and systemic arteriovenous oxygen monitoring after cardiac arrest. Inadequate cerebral oxygen delivery, Resuscitation, 27, pp. 141-152, (1994)

[26]

Kofke, Nemoto, Hossmann, Taylor, Kessler, Stezoski, Brain blood flow and metabolism after global ischemia and post-insult thiopental therapy in monkeys, Stroke, 10, pp. 554-560, (1979)

[27]

Nemoto, Hossmann, Cooper, Post-ischemic hypermetabolism in cat brain, Stroke, 12, pp. 666-676, (1981)

[28]

Thews, Implications to physiology and pathology of oxygen diffusion at the capillary level, Selective vulnerability of the brain in hypoxemia, pp. 27-35, (1963)

[29]

Gotoh, Meyer, Takagi, Cerebral effects of hyperventilation in man, Arch Neurol, 12, pp. 410-423, (1965)

[30]

Eckenhoff, Enderby, Larson, Davies, Judevine, Human cerebral circulation during deliberate hypotension and head-up tilt, J Appl Physiol, 18, pp. 1130-1138, (1963)

← 1 2 3 4 →