抗ショック後の無脈動およびアシストリック心停止からの蘇生のために,心室細動の電気誘導
C T Leng1, R D Berger, H Calkins
1Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, Md, USA. cleng@mail.jhmi.edu
Circulation
|August 8, 2001
まとめ
心停止時のCPRの前にデフィブリレーションを行うと,生存率が低下する可能性があります. 静脈細動 (VF) 中の除細動を遅らせてCPRを継続することは,犬の研究で蘇生時間と生存率を改善しました.
科学分野:
- 心臓病学 心臓病学
- 緊急医療 緊急医療
- 蘇生科学 蘇生科学とは
背景:
- 心肺蘇生手術 (CPR) 前の長期にわたる心室細動 (VF) は生存率を低下させる可能性があります.
- 減少した生存の原因は不明であり,潜在的に,不血性組織の反衝撃や,パルスレス電気活動 (PEA) やアシストーレのようなデフィブリレーション後のリズムに関連している.
研究 の 目的:
- VF中の早期除細動または継続的な心肺蘇生による遅延除細動が蘇生結果に影響するかどうかを調査する.
- デフィブリレーション後のリズム (PEA/アシストール) が,継続したVFと比較して生存率の低下に寄与するかどうかを判断する.
主な方法:
- 15匹の犬を12分間VFに誘導し,ランダムに3つのグループに分けました.
- グループ1: 12分後に除細動され,その後,心臓生命維持器 (ACLS) を受けた.
- 2 グループ: 動脈除細動の前に4分間ACLSでVFを保持した. グループ3: 12分後に除細動,再起細動,そしてACLSの4分後に除細動.
主要な成果:
- デフィブリレーション前にVFを拡張したグループ2と3は,グループ1 (459秒) と比べて,大幅に短い蘇生時間 (245-251秒) を示しました.
- 1時間後の生存率は,グループ2と3 (10/10の犬) とグループ1 (1/5の犬) に比べて有意に改善されました.
- グループ1の早期の除細動はPEA/アシストルを引き起こし,グループ2と3の遅れた除細動は副鼻腔リズムを達成した.
結論:
- VF中の継続的なCPRは,デフィブリレーション後のPEAまたはアシストール中のCPRよりも蘇生に有益であるようです.
- VFの意図的な誘導は,PEAとアシストリック停止の管理に役立つ戦略かもしれません.
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