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Effect of dopamine on oxygen metabolism of swine after restoration of spontaneous circulation

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Author:
No author available
Journal Title:
CHINESE CRITICAL CARE MEDICINE
Issue:
11
DOI:
10.3760/cma.j.issn.1003-0603.2010.11.004
Key Word:
心搏骤停;心肺复苏;多巴胺;氧代谢;猪;Cardiac arrest;Cardiopulmonary resuscitation;Dopamine;Oxygen metabolism;Pig

Abstract: Objective To investigate the impact of different hemoperfusion conditions on oxygen metabolism and the neurological function of swine with restoration of spontaneous circulation (ROSC) after cardiac arrest (CA) following cardiopulmonary resuscitation (CPR) with blood pressure boosted with dopamine.Methods Swan-Ganz catheter was inserted through the right femoral vein, and linked with a continuous cardiac output monitor before ventricular fibrillation (VF).An electrode cable was placed in the right ventricle through left internal jugular vein.Then different catheters were positioned in the aorta and carotid artery successively to consecutively record the indexes of hemodynamics.VF was induced in 12 pigs by programmed electrical stimulation equipment.All animals underwent 4 minutes of untreated VF before CPR by two professional doctors of emergency department.Then all the 12 successfully resuscitated pigs were randomly divided into hypertransfusion group and normal perfusion group with random digits table.Every pig in both groups was given an infusion of normal saline of 15 ml· kg-1 · h-1 within 4 hours.But in the hypertransfusion group, dopamine was administered to pigs to raise the mean arterial pressure (MAP) to about 130% of the baseline.All the pigs were monitored for 4 hours.The hemodynamics and oxygen metabolism parameters were recorded at ROSC 0, 0.5, 1, 2 and 4 hours.At last, animals were evaluated at 24 hours after resuscitation and a swine cerebral performance category (CPC) score was given.Results Compared with normal perfusion group, the hypertransfusion group showed higher oxygen delivery (DO2)and oxygen consumption (VO2) at ROSC 0.5, 1, 2 and 4 hours[DO2(ml/min): 556±43 vs.375±25,660±56 vs.381±53, 674±53 vs.362±44, 685±44 vs.400±38; VO2(ml/min): 288±35 vs.191±13,260±37 vs.204±38, 223±27 vs.169±21, 212±19 vs.163±15, P<0.05 or P<0.01]; the oxygen extraction ratio (ERO2) was decreased at ROSC 1, 2, 4 hours[(39±4)% vs.(53±3)%, (33±2)% vs.(47±1)%, (31±3)% vs.(41±3)%, all P<0.05]; carotid artery blood oxygen partial pressure (PaO2)was increased, but saturation of blood oxygen (SaO2) was not increased; mixed venous blood oxygen partial pressure (P-Vo2, mm Hg, 1 mm Hg=0.133 kPa) was increased at ROSC 0.5, 1, 2 and 4 hours (38±4 vs.33±1, 42±2 vs.36±2, 40±2 vs.36±2, 43±2 vs.38±1, P<0.05 or P<0.01); mixed venous blood oxygen saturation (S-Vo2) and the difference between arterial and venous blood lactate (PCLac) were both increased at ROSC 1, 2, 4 hours[S-Vo2 : 0.60±0.04 vs.0.45±0.03, 0.66±0.02 vs.0.52±0.01, 0.68±0.03vs.0.58±0.03; PCLac (mmol/L): 1.2±0.2 vs.0.7t0.4, 1.0±0.3 vs.0.6±0.2, 1.1±0.2 vs.0.5±0.2, P<0.05 or P<0.01]; arterial blood oxygen content (CAO2) was increased, the difference of oxygen content between arterial and venous blood (CAvO2) and cerebral oxygen extraction ratio (C-ERO2)were decreased, the difference between arterial and venous blood lactate (VALac) was increased.CPC score class 1 was found in 6 pigs in the hypertransfusion group at ROSC 24 hours, CPC score class 2 was found in 3 pigs and 1 pig had CPC score class 1 among 4 pigs in normal perfusion group (P<0.05).Conclusion In this swine model of CPR for VF, dopamine administration could elevate the perfusion pressure of the aorta in the successfully resuscitated animals.Systemic perfusion, cerebral perfusion and oxygen metabolism were improved too.So dopamine was beneficial in early cerebral resuscitation.

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