IONIZED HYPOCALCEMIA DURING PROLONGED CARDIAC-ARREST AND CLOSED-CHEST CPR IN A CANINE MODEL

被引：24

作者：

CAIRNS, CB ^{[1
]}

NIEMANN, JT ^{[1
]}

PELIKAN, PCD ^{[1
]}

SHARMA, J ^{[1
]}

机构：

[1] UNIV CALIF LOS ANGELES,LOS ANGELES CTY HARBOR MED CTR,SCH MED,DEPT EMERGENCY MED,BLDG D-9,TORRANCE,CA 90509

来源：

ANNALS OF EMERGENCY MEDICINE | 1991年 / 20卷 / 11期

关键词：

cardiac arrest; CPR; hypocalcemia;

D O I：

10.1016/S0196-0644(05)81466-0

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Study background: Free or ionized calcium (Ca+2) is known to play a critical role in normal cardiovascular function, and Ca+2 administration in the setting of ionized hypocalcemia has been shown to improve indexes of cardiac function. The value of Ca+2 administration in the setting of cardiac arrest and resuscitation is unproven and controversial, in large part because ionized Ca+2 levels during cardiac arrest and resuscitation have not been adequately studied and exogenous calcium therapy may worsen ischemic cellular injury. Study purpose: To measure free calcium during prolonged cardiac arrest and CPR in a canine model. Methods and measurements: Central arterial and venous catheters were positioned in nine dogs, and ventricular fibrillation (VF) was induced electrically. After seven and one-half minutes of VF, countershocks were administered, and CPR was initiated and performed in accordance with current recommendations for 20 minutes. At five-minute intervals during resuscitation efforts, arterial pH, ionized Ca+2, and lactate as well as aortic pressure were measured. Results: During resuscitation, average systolic arterial pressure was 50 mm Hg. Within five minutes of instituting CPR, ionized Ca+2 significantly decreased from control values (5.1 +/- 0.1 at control to 4.0 +/- 0.1 mg/dL); after 20 minutes of attempted resuscitation, it averaged 3.2 +/- 0.2 mg/dL (P < .05 vs control). There was no change in total Ca+2 during the arrest period (9.2 +/- 0.5 at control to 8.6 +/- 0.8 mg/dL at 27.5 minutes). Arterial lactate significantly increased throughout the arrest and resuscitation period (1.9 +/- 0.2 at control to 7.5 +/- 0.4 mM/L at 27.5 minutes). A significant correlation was demonstrated between ionized Ca+2 and lactate concentrations (r = -.72, P < .001) but not between ionized calcium and pH (r = -.22, P > .20). Conclusion: Ionized hypocalcemia occurs during prolonged cardiac arrest and resuscitation, and ionized hypocalcemia during prolonged arrest and resuscitation may be due to binding by lactate, as has been demonstrated in vitro.

引用

页码：1178 / 1182

页数：5

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