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首页> 外文期刊>Resuscitation. >A new device producing manual sternal compression with thoracic constraint for cardiopulmonary resuscitation.
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A new device producing manual sternal compression with thoracic constraint for cardiopulmonary resuscitation.

机译：一种新的装置，可产生胸腔约束的手动胸骨加压，用于心肺复苏。

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OBJECTIVE: Blood flow during conventional cardiopulmonary resuscitation (CPR) is usually less than adequate to sustain vital organ perfusion. A new chest compression device (LifeBelt) which compresses both the sternum and the lateral thoraces (compression and thoracic constraint) has been developed. The device is light weight, portable, manually powered and mechanically advantaged to minimize user fatigue. The purpose of this study was to evaluate the mechanism of blood flow with the device, determine the optimal compression force and compare the device to standard manual CPR in a swine arrest model. METHODS: Following anesthesia and instrumentation, intravascular contrast injections were performed in four animals and the performance characteristics of the device were evaluated in eight animals. In a comparative outcome study, 42 anesthetized and instrumented swine were randomized to receive LifeBelt or manual CPR. Ventricular fibrillation (VF) was induced electrically and was untreated for 7.5 min. After 7.5 min, countershocks were administered and chest compressions initiated. Pulseless electrical activity (PEA) was observed after one to three shocks in all animals. CPR was continued until restoration of spontaneous circulation (ROSC) or for 10 min after the first shock. If ROSC had not occurred within 5 min of beginning CPR, 0.01 mg/kg of epinephrine (adrenaline) was administered. During CPR, peak systolic aortic pressure (Ao), diastolic coronary perfusion pressure (CPP-diastolic aortic minus diastolic right pressure) and end-tidal CO(2) were measured. RESULTS: Angiographic studies demonstrated cardiac compression as the mechanism of blood flow. Optimal performance, determined by coronary perfusion pressure, was observed at a sternal force of 100-130 lb (45-59 kg). In the comparative trial, significant differences in the measured CPP were observed between LifeBelt and manual CPR both at 1 min (15+/-8 mmHg versus 10+/-6 mmHg, p<0.05) and 5 min (17+/-4 mmHg versus 13+/-7 mmHg, p<0.02) of chest compression. A greater (p<0.05) ETCO(2), a marker of cardiac output and systemic perfusion, was observed with LifeBelt CPR (20+/-7 mmHg) than with manual CPR (15+/-5 mmHg) at 1 min. Peak Ao pressures were not different between methods. With the device, 86% of animals were resuscitated compared to 76% in the manual group. CONCLUSIONS: Blood flow with the LifeBelt device is primarily the result of cardiac compression. At a sternal force of 100-130 lb (45-59 kg), the device produces greater CPP than well-performed manual CPR during resuscitation from prolonged VF.
机译：目的：常规心肺复苏（CPR）期间的血流通常不足以维持重要器官的灌注。已经开发出一种新的胸部按压装置（LifeBelt），该装置可同时压缩胸骨和外侧胸廓（压缩和胸部约束）。该设备重量轻，便携式，手动供电并具有机械优势，可最大程度减少用户疲劳。这项研究的目的是评估该装置的血流机制，确定最佳压缩力，并将该装置与猪停滞模型中的标准手动CPR进行比较。方法：在麻醉和器械治疗之后，对四只动物进行了血管内对比剂注射，并对八只动物进行了设备性能评估。在一项比较结果研究中，随机将42头麻醉和仪器化的猪接受LifeBelt或手动CPR。电诱发心室纤颤（VF），未经治疗7.5分钟。 7.5分钟后，施以反击并开始胸部按压。在所有动物中遭受1到3次电击后，观察到无脉电活动（PEA）。持续进行心肺复苏术直至恢复自发循环（ROSC）或第一次电击后持续10分钟。如果在开始心肺复苏后5分钟内未发生ROSC，则应使用0.01 mg / kg肾上腺素（肾上腺素）。在CPR期间，测量了收缩期主动脉峰值压力（Ao），舒张期冠状动脉灌注压力（CPP-舒张主动脉减去舒张期右压力）和潮气末CO（2）。结果：血管造影研究表明，心脏压迫是血流的机制。在100-130磅（45-59千克）的胸骨力下观察到由冠状动脉灌注压力确定的最佳性能。在比较试验中，在1分钟（15 +/- 8 mmHg与10 +/- 6 mmHg对10 +/- 6 mmHg，p <0.05）和5分钟（17 +/- 4）下，LifeBelt和手动CPR之间观察到的CPP有显着差异mmHg与13 +/- 7 mmHg，p <0.02）的胸部按压。在1分钟时，使用LifeBelt CPR（20 +/- 7 mmHg）观察到比手动CPR（15 +/- 5 mmHg）更大（p <0.05）ETCO（2），这是心输出量和全身灌注的标志。两种方法之间的Ao峰值压力没有差异。使用该装置，可使86％的动物复苏，而人工组为76％。结论：LifeBelt设备的血流主要是心脏受压的结果。胸骨受力为100-130磅（45-59千克）时，从长期的VF进行复苏时，该装置产生的CPP比执行良好的手动CPR更大。

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