| Objective:To compare the differences in hemodynamics,neurological prognosis and brain ultrastructure between subdiaphragmatic lift cardiopulmonary resuscitation and open-heart direct compression cardiopulmonary resuscitation after cardiac arrest in Bama miniature pigs,and to provide theoretical basis for the clinical application of the two kinds of resuscitation methods.Methods:Eighteen Bama miniature pigs were randomly divided into three groups:The cardiopulmonary resuscitation with subdiaphragmatic lift(SL-CPR),the cardiopulmonary resuscitation via opening chest followed by direct heart compression(OC-CPR)and the standard cardiopulmonary resuscitation(S-CPR)groups,6 rats in each group.Each group was given CPR 6 minutes after electroinduced ventricular fibrillation.The SL-CPR group was given subdiaphragmic lift CPR after thoracotomy,the OC-CPR group was given direct compression CPR after thoracotomy,and the S-CPR group was given traditional standard CPR(direct chest compression).The three groups were given continuous ECG blood pressure monitoring and balloon assisted ventilation.Ventilator assisted ventilation after ROSC.The hemodynamic changes after the resumption of spontaneous circulation(ROSC)were monitored 6h and 12 h later.Before fibrillation,6 h and 12 h after ROSC,arterial blood was collected through the femoral artery to detect blood gas analysis indexes,and peripheral venous blood was collected through the internal jugular vein to detect blood lactate,hypersensitive troponin I,creatinine,neuron-specific enolase and S100β protein contents.The animals were sacrificed 12 hours after ROSC,and the survival rate and neurological deficit score of the animals were counted.The ultrastructural changes of frontal cortex were observed under transmission electron microscope.Results:1.The resumption of spontaneous circulationin the SL-CPR group was significantly higher than that in the OC-CPR group[6/6(100%)vs 3/6(50.0%),P<0.05];while the SL-CPR group There was no statistically significant difference between the ROSC rate and the S-CPR group [6/6(100%)vs 5/6(83.3%),P>0.05].2.The survival rate of the SL-CPR group at 12 hours after ROSC was significantly higher than that of the OC-CPR group[6/6(100%)vs 2/3(66.7%),(P <0.05)].However,the survival rate of animals in the SL-CPR group and the S-CPR group was not statistically different [6/6(100%)vs 5/5(100%),(P> 0.05)].3.The preparation time for surgery before cardiopulmonary resuscitation in the SL-CPR group was significantly less than that in the OC-CPR group(32 ± 103 vs 125± 35,P<0.05).4.The duration of cardiopulmonary resuscitation,the number of electrical defibrillation and the amount of adrenaline in the SL-CPR group were significantly less than those in the OC-CPR group(all P<0.05).There was no statistically significant difference in the duration of cardiopulmonary resuscitation,the number of electrical defibrillation and the amount of adrenaline between the SL-CPR group and S-CPR(all P>0.05).5.At 6h and 12 h after ROSC,the mean arterial pressure,coronary perfusion pressure and cardiac output of the SL-CPR group were significantly higher than those of the OC-CPR group at the same time point(all P <0.05).There was no significant difference in mean arterial pressure,coronary perfusion pressure and cardiac output between the SL-CPR group and S-CPR at each time point(all P>0.05).6.At 6 h and 12 h after ROSC,the serum hypersensitivity troponin I and lactate of the SL-CPR group were significantly lower than those of the OC-CPR group at the same time point(all P <0.05).There was no significant difference in serum hypersensitivity troponin I and lactate between the SL-CPR group and S-CPR at each time point(both P>0.05).7.At 6 h after ROSC and 12 h after ROSC,the neuron-specific enolase and S100βprotein in the SL-CPR group were significantly lower than those in the OC-CPR group at the same time point(all P <0.05).There was no significant difference in neuron-specific enolase and S100β protein between SL-CPR group and S-CPR at each time point(both P>0.05).8.Twelve hours after ROSC,the neurological deficit score of the SL-CPR group was significantly lower than that of the OC-CPR group(120 ± 30 vs 190 ± 25,P <0.05).However,the difference between the SL-CPR group and the S-CPR group of pig neurological deficit scores was not statistically significant(120 ± 30 vs 140 ± 35,P>0.05).9.At 12 h after ROSC,the mitochondrial ultrastructural damage of nerve cells in the central anterior gyrus of the frontal cortex in the SL-CPR group was significantly lower than that in the OC-CPR group [3.0(2.8-3.7)vs 1.8(1.2-2.1),P< 0.05],while the ultrastructural changes under the SL-CPR electron microscope were not statistically different from the S-CPR group [3.0(2.8-3.7)vs 3.2(1.8-3.4),P>0.05].Conclusions:Cardiopulmonary resuscitation with subdiaphragmatic lift improves hemodynamics,neurological prognosis and cerebral cortex histopathological damage after cardiac arrest is significantly better than cardiopulmonary resuscitation via opening chest followed by direct heart compression,close to standard cardiopulmonary resuscitation.Cardiopulmonary resuscitation with subdiaphragmatic lift provides a better choice for cardiopulmonary resuscitation for patients with cardiac arrest who are contraindicated with chest compressions. |
