LOWER ESOPHAGEAL SPHINCTER PRESSURE DURING PROLONGED CARDIAC-ARREST AND RESUSCITATION

被引：88

作者：

BOWMAN, FP ^{[1
]}

MENEGAZZI, JJ ^{[1
]}

CHECK, BD ^{[1
]}

DUCKETT, TM ^{[1
]}

机构：

[1] CTR EMERGENCY MED WESTERN PENN,PITTSBURGH,PA 15213

来源：

ANNALS OF EMERGENCY MEDICINE | 1995年 / 26卷 / 02期

关键词：

D O I：

10.1016/S0196-0644(95)70154-0

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Study objective: Unprotected airway ventilation models have been based on a lower esophageal sphincter (LES) pressure found in human beings under general anesthesia. Whether this assumption is applicable during cardiac arrest in human beings is unknown. We attempted to determine the effects of prolonged ventricular fibrillation (VF) on the tension of the LES in a swine model of cardiac arrest. Design: Prospective experimental trial using 18 female mixed-breed domestic swine (mean weight, 21.9+/-2.0 kg). Results: Animals were anesthetized, intubated, and fitted with instruments for the monitoring of LES pressure. LES tone was measured with a LECTRON 302 esophageal monitor (American Antec, Incorporated). VF was induced with a 3-second, 100 mA transthoracic shock and left untreated for 8 minutes; then resuscitation was attempted. LES tension was measured during the first 7 minutes of the arrest. If return of spontaneous circulation (ROSC) occurred, LES pressure was measured for 7 more minutes. The mean baseline LES pressure was 20.6+/-2.8 cm H2O. During minutes 1 through 7 of the arrest the LES tone (mean+/-SD) decreased from 18.0+/-3.0 to 3.3+/-4.2. ROSC occurred in 10 of the 18 trials. In the 7 minutes after ROSC, LES pressure increased from 4.7+/-3.8 to 9.8+/-3.0. Conclusion: This study demonstrated a rapid and severe decrease in LES tone during prolonged cardiac arrest. When ROSC occurred, LES tension increased quickly but did not return to baseline.

引用

页码：216 / 219

页数：4

共 9 条

[1] Melker, Alternate methods of ventilation during respiratory and cardiac arrest, Circulation, 74, pp. IV-63, (1986)
[2] Johannigman, Branson, Davis, Et al., Techniques of emergency ventilation: A model to evaluate tidal volume, airway pressure, and gastric insufflation, J Trauma, 31, pp. 93-98, (1991)
[3] Mosesso, Lukitsh, Menegazzi, Et al., Comparison of delivered volumes and airway pressures when ventilating through an endotracheal tube with bag-valve versus demand-valve, Prehospital Disaster Med, 9, pp. 24-28, (1994)
[4] Ornato, Bryson, Donovan, Et al., Measurement of ventilation during cardiopulmonary resuscitation, Crit Care Med, 11, pp. 79-82, (1983)
[5] Menegazzi, Winslow, In-vitro comparison of bag-valve-mask and the manually triggered oxygen-powered breathing device, Acad Emerg Med, 1, pp. 29-33, (1994)
[6] Ruben, Knudsen, Carugati, Gastric insufflation in relation to airway pressure, Acta Anaesth Scand, 5, pp. 107-114, (1961)
[7] American Heart Association, Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care, JAMA, 269, pp. 2135-2302, (1992)
[8] Elling, Politis, An evaluation of emergency medical technician's ability to use manual ventilation devices, Ann Emerg Med, 12, pp. 765-768, (1983)
[9] Cummins, Austin, Graves, Et al., Ventilation skills of emergency medical technicians: A teaching challenge for emergency medicine, Ann Emerg Med, 15, pp. 1187-1192, (1986)

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