Effects of active abdominal compression-decompression CPR on oxygen metabolism and prognosis in patients with cardiac arrest
10.3760/cma.j.issn.2095-4352.2017.12.013
- VernacularTitle:腹部提压CPR对心搏骤停患者氧代谢及预后的影响
- Author:
Xin SHA
1
,
2
;
新乡医学院
;
Sisen ZHANG
;
Hongwei WANG
;
Yingxin CEN
;
Wei SONG
;
Jing LI
;
Lixiang WANG
Author Information
1. 450003 河南郑州,郑州人民医院急诊与重症医学科
2. 新乡医学院
- Keywords:
Cardiopulmonary resuscitation;
Active abdominal compression-decompression;
Cardiac arrest;
Oxygen metabolism;
Hemodynamics
- From:
Chinese Critical Care Medicine
2017;29(12):1117-1121
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and standard cardiopulmonary resuscitation (STD-CPR) on oxygen metabolism and prognosis of patient with cardiac arrest (CA), and to evaluate the treatment effect of AACD-CPR. Methods Patients with CA, CA time less than 30 minutes, and without STD-CPR and AACD-CPR contraindications admitted to the Zhengzhou People's Hospital from October 1st 2015 to May 31st 2017 were enrolled. The patients were divided into STD-CPR group and AACD-CPR group according to random number table. All patients were given the same rescue measures, if required to give defibrillation; STD-CPR group was operated according to the 2015 American Heart Association (AHA) CPR guidelines; AACD-CPR group was recovered using abdominal lifting and compression cardiopulmonary resuscitation instrument. The oxygen metabolism, hemodynamic, arterial blood gas and prognostic indicators were recorded in the two groups during the resuscitation. Results A total of 69 cases, with STD-CPR group of 34 cases and AACD-CPR group of 35 cases were enrolled finally. ① The oxygen metabolism: during the recovery, compared with STD-CPR group, arterial blood oxygen content (CaO2), arterial-venous oxygen content difference (avDO2), the oxygen carrying capacity (DO2), oxygen consumption (VO2) in AACD-CPR group were significantly increased [CaO2(mL/L): 156±15 vs. 142±19, avDO2(mL/L): 83±14 vs. 73±13, DO2(mL/min): 248±51 vs. 208±54, VO2(mL/min): 134±29 vs. 118±32, all P < 0.05], but there were no significant differences in cardiac output (CO) and mixed venous oxygen content (CvO2). ② Hemodynamic and arterial blood gas: there were no significant differences in the base values of the heart rate (HR), mean arterial pressure (MAP), pH value, pulse oxygen saturation (SpO2), arterial oxygen pressure (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and blood lactate (Lac) between two groups. In the recovery process, MAP, pH value, SpO2, PaO2of two groups were increased, while PaCO2and Lac were decreased. Except MAP of STD-CPR group was slightly higher than AACD-CPR group, the change tendency of AACD-CPR group was more obvious in each index obviously [pH value difference: 0.10±0.15 vs. 0.02±0.13, SpO2difference: 0.311±0.255 vs. 0.159±0.232, PaO2 difference (mmHg, 1 mmHg = 0.133 kPa): 12.96±21.84 vs. 3.01±13.56, PaCO2difference (mmHg): -9.91±11.17 vs.-3.52±13.87, Lac value difference (mmol/L): -0.64±0.61 vs. -0.31±0.58, all P < 0.05]. ③ Prognosis: compared with STD-CPR group, the restoration of spontaneous circulation (ROSC) rate in AACD-CPR group was slightly increased (22.9% vs. 8.8%, P > 0.05), but the ROSC time in AACD-CPR group was significantly shortened (minutes: 9.59±2.67 vs. 11.83±3.05, P < 0.01), nerve function defect score (NDS) was significantly decreased at 1, 2 weeks (26.45±6.42 vs. 30.73±7.38, 19.25±6.27 vs. 22.64±5.63, both P < 0.05), and the 2-week survival was slightly increased (17.1% vs. 5.9%, P > 0.05). Conclusion AACD-CPR is similar to STD-CPR in improving hemodynamics of CA patients, but has advantage in the blood oxygen supply for tissues and organs, and the neurological function prognosis is better.
