Open-chest CPR improves survival and neurologic outcome following cardiac arrest

被引:35
作者
Benson, DM
O'Neil, B
Kakish, E
Erpelding, J
Alousi, S
Mason, R
Piper, D
Rafols, J
机构
[1] St Johns Hosp, Dept Emergency Med, Detroit, MI 48236 USA
[2] St Johns Hosp, Dept Surg, Detroit, MI 48236 USA
[3] St Johns Hosp, Dept Grad Med Educ, Detroit, MI 48236 USA
[4] Wayne State Univ, Sch Med, Dept Anat & Cell Biol, Detroit, MI 48201 USA
[5] Wayne State Univ, Sch Med, Dept Emergency Med, Detroit, MI 48201 USA
关键词
cardiac arrest; open-chest cardiac compression; closed-chest cardiac massage; neurologic dysfunction; brain ischemia;
D O I
10.1016/j.resuscitation.2003.03.001
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objective: To determine if 15 min of open-chest cardiac massage (OC-CPR) versus closed-chest compressions (CC-CPR) improves 72-h survival and neurologic outcome (behavioral and histologic) after 5 min of untreated cardiac arrest. Methods: Mongrel dogs were anesthetized and instrumented. Cardiac arrest was induced by KCI injection and after a 5-min period of non-intervention, dogs were randomized to receive either CC-CPR (N = 7) or OC-CPR (N = 5) performed for 15 min. The dogs were then resuscitated and physiologic data was recorded. Surviving dogs were scored at 72 h using canine neurodeficit score of Safar et al. (NDS; 0 = behaviorally normal, 500 = brain death). Dogs that could not be resuscitated or died before 72 h were assigned a score of 500. Brain histology was performed on all survivors. Results: All OC-CPR dogs were successfully resuscitated and were behaviorally normal at 72 h (NDS = 0). Histology in OC-CPR dogs showed little to no injury. Only three out of the seven CC-CPR dogs survived to 72 h. Of the survivors, one dog exhibited minor ataxia (NDS = 15), and two had incapacitating deficits (both NDS = 180). Two dogs died within 24 It after extubation, and one could not be resuscitated and the other could not be weaned from the ventilator (each NDS = 500). Histology of the CC-CPR survivors revealed moderate to severe lesions. NDS between groups was statistically significant (p < 0.0079). Conclusion: In our canine model of cardiac arrest, OC-CPR significantly improved 72-h survival and neurologic outcome when compared to CC-CPR. (C) 2004 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:209 / 217
页数:9
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