Comparative Study Between Percutaneous Cardiopulmonary Support And Conventional Method For Cardiopulmonary Resuscitation

1.ObjectiveResearches revealed that systolic pressure peak could reach 60 to 80 mm Hg under correct close-chest compression in cardiopulmonary resuscitation(CP R),but carotid arterial pressure rarely exceeded 40mmHg,also cerebral and cor onary blood flow only reached respectively 10 percent and 5 percent blood flo w as normal.Although resuscitative thoracotomy could increase the blood flow twice and supply better physiological function comparing to conventional cardi opulmonary resuscitation,its survival rate was lower than the latter's.In 1983,Phillips and his colleagues refered cardiac angiography technique by Seldinger-method and percutaneous trocar applied in intra-aortic balloon pump(IABP) to establish a new cardiopulmonary bypass technique,percutaneous cardiopulmonary bypass support system(PCPS).The new cardiopulmonary bypass method didn't obstruct conventional cardiopulmonary resuscitation and could supply effective perfusion to organs and tissue rapidly and conveniently. After referring the infants,newborns and children extracorporeal membrane oxygenation method,we found right carotid artery maybe an appropriate cannulation position,because right carotid artery is fixed and easy to be dissected or punctured. Also its diameter is wide enough and can be cannulated big tube into it.We want to find out if the carotid artery cannulation is same as conventional cardiopulmonary resuscitation and femoral artery cannulation on coronary arterial perfusion pressure, restoration of spontaneous circulation time and rate.We hope to provide new methods for applying percutaneous cardiopulmonary bypass support in clinic.Some resuscitation indicators were chosen including mean arterial pressure, coronary arterial pressure,restoration of spontaneous circulation time and rate.Some scientist pointed out that coronary arterial pressure has a positive correlation with myocardial flow,restoration of spontaneous circulation rate and hospital discharge rate.So we set down these monitor indicators to observe the changes within different methods of cardiopulmonary resuscitation,and then discover the effect in different methods of cardiopulmonary resuscitation and different cannulation position.The purpose of this research is to find out a more scientific and intact academic system in emergency medicine that can increase patients' survival rate in critical diseases.2.Material and Method2.1 Experimental animalEighteen experimental animals were healthy and ripe male dogs whose b ody weight from 17kg to 26kg.Animals were randomly and medially divided i nto three groups.All animals were asphyxiated to cardiac arrest.Group A ani mal processed conventional cardiopulmonary resuscitation.Group B animals had undergone a cardiopulmonary resuscitation by cannulating femoral vein to esta blish cardiopulmonary bypass and Group C animals by puncturing carotid arter y.2.2 Monitor indicatorIncluding Central venous pressure,Aortic systolic pressure,Aortic diastoli c pressure,mean arterial pressure,coronary arterial perfusion pressure,cardiopu lmonary bypass establish time,blood gas analysis,restoration of spontaneous ci rculation time,electrolyte,uninterrupted monitor in electrocardiogram,cardiac rhythm and arterial oxygen percent saturation.2.3 Experimental procedureGroup A:We start to resuscitate animals after they were cardiac arrest pa ssing 8 minute by clamping tracheal catheter.Resuscitation procedures strictly were according to the 2005 American Heart Association(AHA)guidelines for cardiopulmonary resuscitation.Group B:Except conventional cardiopulmonary resuscitation after cardiac a rrest,animals were injected 3mg/kg a dose of heparin and then dissected unilat eral femoral artery and contralateral femoral vein to establish cardiopulmonary bypass applying Seldinger method to cannulate.Group C:All procedures were same as Group B except carotid arterial ca nnulation.3.Result3.1 There is not statistic difference on time from asphyxiation to cardiac arrest within three groups. 3.2 Only one animal was successful restoration of spontaneous circulation in Group A.The restoration of spontaneous circulation rate in Group A and B is 100 percent. The restoration of spontaneous circulation time in Group C was shorter than that in Group B.3.3 Before restoration of spontaneous circulation,partial pressure of carbon dioxide in group A is higher than that in group B and C and arterial oxygen tension in group A is lower than that in group B and C.There was not statistic difference on partial pressure of carbon dioxide between group A and B.Before restoration of spontaneous circulation,arterial oxygen tension in Group B is lower than that in group C.After restoration of spontaneous circulation,arterial oxygen tension in two groups didn't exist difference.3.4 Hemodynamic indicator.Central venous pressure in Group A was higher than that in group B and C before restoration of spontaneous circulation.Aortic systolic pressure,aortic diastolic pressure,coronary arterial perfusion pressure and mean arterial pressure in group A were lower than these in group B and C.Central venous pressure between group B and C was not different in statistics.Before restoration of spontaneous circulation,Aortic systolic pressure,aortic diastolic pressure,coronary arterial perfusion pressure and mean arterial pressure in Group B were lower than these in Group C.After restoration of spontaneous circulation,these indicators between two groups were not different in statistics.4.Conclusion4.1 Percutaneous cardiopulmonary bypass support combined with conventional cardiopulmonary resuscitation can obviously increase the restoration of spontaneous circulation rate,improve blood gas and supply stable hemodynamic support.It is an effective measure to salvage patients.4.2 Perfusion tube close to ascend aortic root maybe can shorten restoration of spontaneous circulation time and supply higher coronary arterial perfusion pressure and better blood gas than that away from ascend aortic root.