心肺脳蘇生におけるCardiopulmonary Bypassの有用性に関する研究

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  • The Advantages of Cardiopulmonary Bypass for Cardiopulmonary Cerebral Resuscitation

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Recently cardiopulmonary resuscitation （CPR） is actively and widely performed in cases of dead on arrival （DOA）. The standard external CPR, however, is limited in the ability to increase the survival rate, particularly the rates of hospital discharge and neurological recovery. A new resuscitiation method which reliably regains effective spontaneous circulation is needed. This study was performed to clarify the beneficial mechanism and effect of cardiopulmonary by- pass （CPB） on cardiopulmonary cerebral resuscitation and the clinical usefulness of CPB for resusci- tation of DOA patients. Following cardiac arrest from 10 minutes of ventricular fibrillation, twenty adult mongrel dogs were divided into two groups. In the CPR group （n=10）, standard external cardiopulmonary resus- citation was used for restoration of spontaneous cardiac circulation （ROSC）. In the CPB group （n=10）, cardiopulmonary bypass was used for early defibrillation and to assist the systemic circula- tion for 60 minutes. During resuscitation, systemic and cerebral hemodynamics, including superior sagittal sinus velocity （SSSV） were obtained. SSSV was measured as the index of cerebral blood flow （CBF） by using pulsed doppler methods. ROSC, stable hemodynamics and early neurological recovery after ROSC were compared between the CPR and CPB groups. Cerebral blood flow by using hydrogen clearance methods and metabolism of post ROSC in the CPB group were compared with those in the CPR group. In these experimental studies, the following results were obtained. 1） CPB produced significantly higher cerebral and coronary per fusion pressures and larger CBF during resuscitation as compared with those in the CPR group. 2） CPB achieved ROSC more successfully （9 of 10 vs 4 of 10 in the CPR group）, and enhanced the ROSC time （mean, 5.7 minutes vs 10.6 minutes in the CPR group）. In the CPB group, the required energy for deflbrillation was less than that in the CPR group. 3） CPB achieved stabilization of hemodynamics after ROSC and improved the 90 minute survival （9 of 10 vs 2 of 10 in the CPR group）. All 9 dogs with ROSC survived throughout the protocol time （90 minutes） and 5 dogs were weaned to spontaneous circulation. 4） CPB increased early neurological recovery （8 of 10 vs 1 of 10 in the CPR group）. In the CPB group, 8 of 9 with ROSC regained spontaneous breathing and movements and 7 of 9 achieved the return of electroencephalogram activity and auditory brainstem response. 5） The cerebral metabolic studies were not able to compare the two group because of the low number of specimens in the CPR group. The average values of regional CBF and cerebral metabolic rate for oxygen in the CPB group were higher than those of the surviving case （No.8） in the CPR group. External CPR methods produced low mean arterial and high central venous pressure, and therefore low coronary per fusion pressures. Chest compression caused high intracranial pressure, which resulted in low CBF. Those findings indicate the advantages of CPB as a cardiopulmonary cerebral resuscitation method; CPB gives good cardiovascular resuscitability, good CBF during resuscitation and good neurological recovery compared to standard CPR.

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