Standardiseret model af ventrikulær fibrillering og avanceret hjerteliv støtte i svin
Summary
Kardiopulmonal genoplivning og defibrillering er de eneste effektive terapeutiske muligheder under hjertestop forårsaget af ventrikelflimmer. Denne model præsenterer en standardiseret regime til at fremkalde, vurdere og behandle denne fysiologiske tilstand i en svinemodel, hvilket giver en klinisk tilgang med forskellige muligheder for dataindsamling og analyse.
Abstract
Kardiopulmonal genoplivning efter hjertestop, uafhængigt af dens oprindelse, er en regelmæssigt stødt på medicinsk nødsituation på hospitaler samt prækliniske indstillinger. Prospektive randomiserede forsøg med mennesker er vanskelige at designe og etisk tvetydige, hvilket resulterer i en mangel på evidensbaserede behandlinger. Den model, der præsenteres i denne betænkning, er en af de mest almindelige årsager til hjertestop, ventrikelflimmer, i en standardiseret indstilling i en stor dyremodel. Dette giver mulighed for reproducerbare observationer og forskellige terapeutiske indgreb under klinisk nøjagtige forhold, hvilket letter genereringen af bedre dokumentation og i sidste ende potentialet for forbedret medicinsk behandling.
Introduction
Hjertestop og kardiopulmonal genoplivning (CPR) er regelmæssigt stødt på medicinske nødsituationer på hospitalsafdelinger samt prækliniske akutudbyder scenarier1,2. Selv om der har været en omfattende indsats for at karakterisere den optimale behandling af denne situation3,4,5,6, internationale retningslinjer og ekspertanbefalinger (f.eks. erC og ILCOR) normalt afhængige af lav kvalitet beviser på grund af manglen på potentielle randomiserede forsøg3,4,5,7,8,9. Dette skyldes til dels åbenlyse etiske forbehold med hensyn til randomiserede genoplivningsprotokoller i humane forsøg10. Dette kan dog også pege på en mangel på streng protokoloverholdelse, når de konfronteres med en livstruende og stressende situation11,12. Protokollen præsenteres i denne rapport har til formål at give en standardiseret genoplivning model i en realistisk klinisk indstilling, som genererer værdifulde, potentielle data og samtidig være så gyldig og præcis som muligt uden behov for forsøgspersoner. Det overholder fælles genoplivning retningslinjer, kan nemt anvendes, og gør det muligt for forsker at undersøge og karakterisere forskellige aspekter og interventioner i en kritisk, men kontrolleret indstilling. Dette vil føre til 1) en bedre forståelse af de patologiske mekanismer, der ligger til grund for hjertestop og ventrikelflimmer og 2) højere kvalitet beviser for at optimere behandlingsmuligheder og øge overlevelsesraten.
Protocol
Representative Results
Discussion
Nogle vigtige tekniske spørgsmål vedrørende anæstesi i en svinemodel er tidligere blevet beskrevet af vores gruppe13,14. Disse omfatter streng undgåelse af stress og unødvendigsmerte for dyrene, mulige anatomiske problemer under luftvejsstyring og specifikke personalekrav19.
Derudover blev fordelene ved ultralydstyret kateterisering fremhævet tidligere og er fortsat den foretrukne tilgang til at forhindre…
Divulgations
The authors have nothing to disclose.
Acknowledgements
Forfatterne vil gerne takke Dagmar Dirvonskis for fremragende teknisk support.
Materials
| 1 M- Kaliumchlorid-Lösung 7,46% 20ml | Fresenius, Kabi Deutschland GmbH | potassium chloride | |
| Arterenol 1mg/ml 25 ml | Sanofi- Aventis, Seutschland GmbH | norepinephrine | |
| Atracurium Hikma 50mg/5ml | Hikma Pharma GmbH, Martinsried | atracurium | |
| BD Discardit II Spritze 2,5,10,20 ml | Becton Dickinson S.A. Carretera Mequinenza Fraga, Spain | syringe | |
| BD Luer Connecta | Becton Dickinson Infusion Therapy AB Helsingborg, Schweden | 3-way-stopcock | |
| BD Microlance 3 20 G | Becton Dickinson S.A. Carretera Mequinenza Fraga, Spain | canula | |
| CorPatch Easy Electrodes | CorPuls, Kaufering, Germany | defibrillator electrodes | |
| Corpuls 3 | Corpuls, Kaufering, Germany | defibrillator | |
| Datex Ohmeda S5 | GE Healthcare Finland Oy, Helsinki, Finland | hemodynamic monitor | |
| Engström Carestation | GE Heathcare, Madison USA | ventilator | |
| Fentanyl-Janssen 0,05mg/ml | Janssen-Cilag GmbH, Neuss | fentanyl | |
| Führungsstab, Durchmesser 4.3 | Rüsch | endotracheal tube introducer | |
| Incetomat-line 150 cm | Fresenius, Kabi Deutschland GmbH | perfusorline | |
| Ketamin-Hameln 50mg/ml | Hameln Pharmaceuticals GmbH | ketamine | |
| laryngoscope | Rüsch | laryngoscope | |
| logicath 7 Fr 3-lumen 30cm lang | Smith- Medical Deutschland GmbH | central venous catheter | |
| LUCAS-2 | Physio-Control/Stryker, Redmond, WA, USA | chest compression device | |
| Masimo Radical 7 | Masimo Corporation Irvine, Ca 92618 USA | periphereal oxygen saturation | |
| Neofox Oxygen sensor 300 micron fiber | Ocean optics Largo, FL USA | ultrafast pO2-measurements | |
| Ölsäure reinst Ph. Eur NF C18H34O2 M0282,47g/mol Dichte 0,9 | Applichem GmbH Darmstadt, Deutschland | oleic acid | |
| Original Perfusor syringe 50ml Luer Lock | B.Braun Melsungen AG, Germany | perfusorsyringe | |
| Osypka pace, 110 cm | Osypka Medical GmbH, Rheinfelden-Herten, Germany | Pacing/fibrillation catheter | |
| PA-Katheter Swan Ganz 7,5 Fr 110cm | Edwards Lifesciences LLC, Irvine CA, USA | PAC | |
| Percutaneous sheath introducer set 8,5 und 9 Fr, 10 cm with integral haemostasis valve/sideport | Arrow international inc. Reading, PA, USA | introducer sheath | |
| Perfusor FM Braun | B.Braun Melsungen AG, Germany | syringe pump | |
| Propofol 2% 20mg/ml (50ml flasks) | Fresenius, Kabi Deutschland GmbH | propofol | |
| Radifocus Introducer II, 5-8 Fr | Terumo Corporation Tokio, Japan | introducer sheath | |
| Rüschelit Super Safety Clear >ID 6/ 6,5 /7,0 mm | Teleflex Medical Sdn. Bhd, Malaysia | endotracheal tube | |
| Seldinger Nadel mit Fixierflügel | Smith- Medical Deutschland GmbH | seldinger canula | |
| Sonosite Micromaxx Ultrasoundsystem | Sonosite Bothell, WA, USA | ultrasound | |
| Stainless Macintosh Größe 4 | Welsch Allyn69604 | blade for laryngoscope | |
| Stresnil 40mg/ml | Lilly Deutschland GmbH, Abteilung Elanco Animal Health | azaperone | |
| Vasofix Safety 22G-16G | B.Braun Melsungen AG, Germany | venous catheter | |
| Voltcraft Model 8202 | Voltcraft, Hirschau, Germany | oscilloscope/function generator |
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