猪心室颤动和高级心脏生命支持标准化模型
Summary
心肺复苏和除颤是心室颤动引起的心脏骤停期间唯一有效的治疗方案。该模型提出了在猪模型中诱导、评估和治疗这种生理状态的标准化方案，从而提供了一种临床方法，为数据收集和分析提供了各种机会。
Abstract
心脏骤停后心肺复苏，与心脏骤停无关，是医院以及临床前经常遇到的医疗紧急情况。人体的前瞻性随机试验难以设计，在伦理上模棱两可，导致缺乏循证疗法。本报告中提出的模型代表了心脏骤停、心室颤动的最常见原因之一，在大型动物模型中的标准化环境中。这允许在临床准确条件下进行可重复的观察和各种治疗干预，从而有助于生成更好的证据，并最终改善医疗治疗的潜力。
Introduction
心脏骤停和心肺复苏（CPR）是医院病房中经常遇到的医疗紧急情况，以及临床前急诊提供者方案1，2。虽然已经作出广泛的努力来描述这种情况的最佳治疗3，4，5，6，国际准则和专家建议（例如，ERC和ILCOR）通常依靠低级证据，由于缺乏前瞻性的随机试验3，4，5，7，8，9。这在一定程度上是由于在人体试验10中关于随机复苏协议的明显伦理保留。然而，这也可能指向在面对威胁生命和压力的情况11，12时缺乏严格的协议遵守。本报告提出的协议旨在提供一个标准化的临床复苏模型，在无需人体受试者的情况下，生成有价值的前瞻性数据，同时尽可能有效和准确。它遵循共同的复苏指南，易于应用，使研究能够在关键但有控制的环境中检查和描述各个方面和干预措施。这将导致 1） 更好地了解心脏骤停和心室颤动背后的病理机制，2） 高质量的证据，以优化治疗方案和提高存活率。
Protocol
这一议定书的实验得到了国家和机构动物照料委员会的批准（德国科布伦茨州兰登苏松桑特莱茵兰-普法尔茨;主席：西尔维亚·艾施-沃尔夫博士;批准号。G16-1-042）。实验是按照《到达指南》进行的。七只麻醉雄猪（susscrofa家猪），平均体重为30~2公斤，年龄为12-16周。 1. 麻醉、插管和机械通风13、14 尽可能长时间地保持…
Representative Results
七头猪心脏骤停。四头猪在心肺复苏后自发循环的回归（57%）均值为 3 × 1 双相颤化。在整个实验中，健康且充分麻醉的猪应保持苏皮状态，没有颤抖和激动的迹象。平均动脉血压不应降到50毫米汞柱以下，然后开始颤动18。为了获得最佳结果，可以进行血气分析，并对所有值（包括温度）进行标准化。 如果?…
Discussion
关于猪模型麻醉的一些主要技术问题，我们小组13，14已经描述了。这些措施包括严格避免动物的压力和不必要的疼痛，在气道管理中可能出现的解剖问题，以及具体的人员要求19。
此外，超声导管插入的好处以前已经强调，并且仍然是在仪器仪表期间防止血管损伤的可取方法。然而，只有经过专业培训的用户才能…
Disclosures
The authors have nothing to disclose.
Acknowledgements
作者要感谢达格玛·迪尔文斯基斯的出色技术支持。
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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Cite This Article
Ruemmler, R., Ziebart, A., Garcia-Bardon, A., Kamuf, J., Hartmann, E. K. Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine. J. Vis. Exp. (155), e60707, doi:10.3791/60707 (2020).